Basic Information
| Provider Information | |||||||||
| NPI: | 1679541452 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PICKER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10867 W FLORISSANT AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631362405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148175367 | ||||||||
| FaxNumber: | 3145221027 | ||||||||
| Practice Location | |||||||||
| Address1: | 3718 S KINGSHIGHWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631091800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144461134 | ||||||||
| FaxNumber: | 3144461136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TO2576 | MO | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 318498318 | 05 | MO | MEDICAID | 2230948 | 01 | UNITED HEALTHCARE | OTHER | 56418 | 01 | MO | HEALTHCARE USA | OTHER | 188384 | 01 | HEALTHLINK | OTHER | 5311 | 01 | MERCY HEALTH PLAN | OTHER | MO2576 | 01 | EYEMED | OTHER | 197948 | 01 | BLUE CROSS BLUE SHIELD MO | OTHER |