South County Eye Care

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

MDR9N88 Issued in MO

Legal business name

SOUTH COUNTY EYE CARE

Doing business as

South County Eye Care

Practice address

13131 Tesson Ferrry Rd #108
St Louis, MO 63128

Phone

(314) 843-5800

Fax

(314) 843-5290

NPI assigned

Oct 4, 2006

Last updated

Feb 19, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brandi Nicole Polk

Title

Admin

Phone

(314) 843-5800

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• South County Eye Care Doing business as

Locations

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550534400000",
    "number": "1801981899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13131 TESSON FERRRY RD #108",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63128",
            "telephone_number": "314-843-5800",
            "fax_number": "314-843-5290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13131 TESSON FERRRY RD #108",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63128",
            "telephone_number": "314-843-5800",
            "fax_number": "314-843-5290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY EYE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2019-02-19",
        "status": "A",
        "authorized_official_last_name": "POLK",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "314-843-5800"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MO",
            "license": "MDR9N88",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203015219",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MO LICENSE #",
            "identifier": "MDR9N88",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South County Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South City Hearing & Audiology, LLC
• South County Anesthesia Associates, LTD.
• South County Comprehensive Care LLC
• South County Dental Imaging Center
• South County Endocrinology and Obesity Medicine LLC
• South County Family Dental, Inc
• South County Imaging Center LLC
• South County Internal Medicine Inc.
• South County Orthopedics and Sports Medicine Inc
• South County Outpatient Surgery Center LP

• Preferred Provider Organization in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Preferred Provider Organization in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.