PEC SOUTH COUNTY LLC (NPI# 1295371946) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295371946 |
| Entity Type | Organization |
| Organization Name | PEC SOUTH COUNTY LLC |
| Practice Address |
4412 Telegraph Rd Saint Louis MO 63129-3316 |
| Mailing Address |
4111 N Illinois St Swansea IL 62226-7609 |
| Practice Telephone | 6182343053 |
| Mailing Telephone | 6182343053 |
| Enumeration Date | 2019-11-18 |
| Last Update Date | 2019-11-18 |
| Authorized Official Name | DIRK MASSIE (OPTOMETRIST/OWNER) |
| Authorized Official Telephone | 6182343053 |
| Authorized Official Credential | OD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
Eye and Vision Services Providers |
| Other Name | Type Code |
|---|---|
| Performance Eyecare | Doing Business As Name - Organization |
| Street Address |
4412 TELEGRAPH RD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63129-3316 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558458521 | Ernest C Doiron | Optometrist | 4412 Telegraph Rd, Saint Louis, MO 63129-3316 | 2006-10-09 |
| 1841445236 | Clarkson Optometry Inc | Optometrist | 4412 Telegraph Rd, Saint Louis, MO 63129-3316 | 2008-11-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447730742 | Total Access Urgent Care, PC | Clinic/Center | 4400 Telegraph Road, 4400 Telegraph Road, St. Louis, MO 63129 | 2018-08-16 |
| 1679061808 | Susan Swyers Grogan | Occupational Therapist | 2806 Flamewood Drive, St. Louis, MO 63129 | 2018-04-24 |
| 1376073981 | Eric Piatchek | Specialist/Technologist | 2661 Bluff Ridge Drive, St. Louis, MO 63129 | 2017-06-15 |
| 1033647144 | Keona E Smith | Nurse Practitioner | 7334 Lindbergh Blvd, Ballwin, MO 63129 | 2017-06-02 |
| 1588036966 | Sarah Michelle Corry | Occupational Therapist | 5043 Telegraph Rd, St Louis, MO 63129 | 2015-10-26 |
| 1598169120 | Vivian Carr | Counselor | 5266 Sir Bors Drive, St. Louis, MO 63129 | 2014-10-10 |
| 1982044327 | Andrew Michael Bryant | Family Medicine | 4280 Mid America Lane, Saint Louis, MO 63129 | 2013-06-30 |
| 1306185533 | John Alexander Miller | Registered Nurse | 4220 Robert Koch Hospital Rd, Saint Louis, MO 63129 | 2013-02-07 |
| 1346597457 | Pain and Performance Relief LLC | Physical Medicine & Rehabilitation | 4175 Crescent Dr Ste A, Saint Louis, MO 63129 | 2012-08-08 |
| 1366721516 | Teresa Lyn Bitter | Speech-Language Pathologist | 7325 Summerview Manor Lane, St. Louis, MO 63129 | 2011-08-05 |
| Find all providers in zip 63129 | ||||
| Taxonomy Code | 152WC0802X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Specialization | Corneal and Contact Management |
| The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea’s ability to sustain successful contact lens wear, and treatment of any external eye or corneal condition which can affect contact lens wear. |
| Notes: Source: American Optometric Association [1/1/2009: added definition, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508086166 | Marlin B Neil | Optometrist | 12312 Olive Blvd Ste 150, Saint Louis, MO 63141-5468 | 2007-04-26 |
| 1588722748 | Morio Miyamoto | Optometrist | 720 Olive St, Suite 420, Saint Louis, MO 63101-2338 | 2006-12-04 |
| 1952725210 | Altenbernd Family Eye Care, LLC | Optometrist | 5445 Telegraph Rd, Suite 119, Saint Louis, MO 63129-3500 | 2014-02-06 |
| 1770664625 | Fontana Eyecare Associates, LLC. | Optometrist | 16 Hampton Village Plz, Suite 249, Saint Louis, MO 63109-2128 | 2006-10-18 |
| 1124037320 | Thebe Bagwasi | Optometrist | 3270 Telegraph Rd, Saint Louis, MO 63125-5565 | 2006-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114056231 | Kevin Greeley Lydon | Optometrist | 6764 Mexico Rd, Saint Peters, MO 63376-1505 | 2007-03-05 |
| 1184759284 | Ralph Melvin Butler | Optometrist | 401 Supercenter Dr, Walmart Vision Center, Jefferson City, MO 65101-8190 | 2007-02-22 |
| 1972645919 | Thomas Stanley Sandler | Optometrist | Jc Penney Optical, 4 Mid Rivers Mall Drive, St. Peters, MO 63376 | 2007-02-13 |
| 1811039910 | Rick Jon Unsell | Optometrist | 7436 Nw River Park Dr, Parkville, MO 64152-5028 | 2007-02-13 |
| 1659421303 | Ira Nathan Ettinger | Optometrist | 1701 Aroy Dr., Washington, MO 63090 | 2007-01-12 |
| 1578649547 | Lawrence Allen Aurich | Optometrist | 12420 So. 71 Highway, Grandview, MO 64030 | 2006-10-31 |
| 1093823924 | Jeffrey Donald Laferla | Optometrist | 8301 N Congress Ave, Kansas City, MO 64152-2041 | 2006-08-29 |
| 1356454060 | Frank Joseph Bier | Optometrist | 14037 Manchester Rd, Manchester, MO 63011-4513 | 2006-08-16 |
| 1548206576 | William H Gosnell | Optometrist | 17950 E 39th St S, Independence, MO 64055-3850 | 2006-06-20 |
| 1144262536 | Gerald Robert Gosnell | Optometrist | 4631 Wyandotte, Kansas City, MO 64112-1542 | 2006-06-12 |
| Find all providers with the same taxonomy | ||||
| City | SAINT LOUIS |
| Zip Code | 63129 |
Please comment or provide details below to improve the information on PEC SOUTH COUNTY LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.