Basic Information
| Provider Information | |||||||||
| NPI: | 1447655691 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED SIGHT CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 JEFFERSON ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630906449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362391650 | ||||||||
| FaxNumber: | 6362399005 | ||||||||
| Practice Location | |||||||||
| Address1: | 3454 MCKELVEY RD | ||||||||
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| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630442533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148223776 | ||||||||
| FaxNumber: | 3148226281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2014 | ||||||||
| LastUpdateDate: | 10/31/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHORT | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | NEWTON | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/OPHTHALMOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 6362391650 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, FACS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.