NPIMap

Organization Active NPI

Surevision Eye Centers Midwest LLC

Doing business as SureVision Eye Centers

  • Ophthalmology Physician
  • Creve Coeur, MO
National Provider Identifier
1699857912
Registry record updated Sep 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SUREVISION EYE CENTERS MIDWEST LLC
Doing business as
SureVision Eye Centers
Practice address
12101 Woodcrest Executive Dr Ste 150
Creve Coeur, MO 63141-5050
Phone
(314) 921-2020
Fax
(314) 863-9977
NPI assigned
Oct 19, 2006
Last updated
Sep 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2023

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

Authorized official

Name
Shelley Lynn Miana, COE
Title
Coo
Phone
(314) 726-5669

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

12101 Woodcrest Executive Dr Ste 150
Creve Coeur, MO 63141-5050

Mailing address

320 Brookes Dr
Suite 111
Hazelwood, MO 63042-2736
Phone (314) 726-5669

Other names 1

  • SureVision Eye Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031209001023 IL Part B Supplier - Clinic/Group Practice 1850297904 Receives reassigned benefits from 4 practitioners
Practice locations: Alton, IL
O20040423000661 MO Part B Supplier - Clinic/Group Practice 1850297904 Receives reassigned benefits from 6 practitioners
Practice locations: Saint Louis, MO

National Provider Directory

National Provider Directory

Locations

1 Park Pl
Swansea, IL 62226
Phone (618) 233-3040

320 Brookes Dr
Ste 111
Hazelwood, MO 63042
Phone (314) 726-5669

12101 Woodcrest Executive Dr
Ste 150
Saint Louis, MO 63141
Phone (314) 391-9400

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694995200000",
    "number": "1699857912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 BROOKES DR",
            "address_2": "SUITE 111",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630422736",
            "telephone_number": "314-726-5669",
            "fax_number": "314-726-5109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12101 WOODCREST EXECUTIVE DR STE 150",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631415050",
            "telephone_number": "314-921-2020",
            "fax_number": "314-863-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUREVISION EYE CENTERS MIDWEST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A",
        "authorized_official_last_name": "MIANA",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "314-726-5669",
        "authorized_official_credential": "COE"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SureVision Eye Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SureVision Eye Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Creve Coeur, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.