Des Peres Eye Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

DES PERES EYE SURGERY CENTER, LLC

Doing business as

St Louis Eye Surgery and Laser Center

Practice address

12990 Manchester Rd
Suite 103
Saint Louis, MO 63131-1860

Phone

(314) 686-4200

Fax

(314) 686-4217

NPI assigned

Mar 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Melanie Kofron, MHA

Title

Administrator

Phone

(314) 686-4200

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• St Louis Eye Surgery and Laser Center Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Listed as

St Louis Eye Surgery and Laser CtrCCN 26C0001125

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Clarkson Optometry Inc

  • Optometrist
  • Saint Louis, MO
  • NPI 1790026540

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John B Holds, MD

  • Plastic and Reconstructive Surgery Physician
  • Saint Louis, MO
  • NPI 1134117732
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1548399561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12990 MANCHESTER RD",
            "address_2": "SUITE 103",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631311860",
            "telephone_number": "314-686-4200",
            "fax_number": "314-686-4217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12990 MANCHESTER RD",
            "address_2": "SUITE 103",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631311860",
            "telephone_number": "314-686-4200",
            "fax_number": "314-686-4217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DES PERES EYE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "KOFRON",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "314-686-4200",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00461792",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548399561",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Louis Eye Surgery and Laser Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Courtney Deronde, BCBA
• Michael J Derosa, M.D.
• Lori Derosear, D.O.
• Edward Justin Derrick, MD
• Paula Jean Deruntz, NP
• Des Peres Family Medicine
• Des Peres Family Medicine PC
• Des Peres Healthmart Pharmacy LLC
• Des Peres Hospital
• Des Peres Hospital

• Ambulatory Surgical Clinic/Center in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.