Provider Demographics
NPI:1447655691
Name:ADVANCED SIGHT CENTER, INC
Entity type:Organization
Organization Name:ADVANCED SIGHT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:NEWTON
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:636-239-1650
Mailing Address - Street 1:1351 JEFFERSON ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-6449
Mailing Address - Country:US
Mailing Address - Phone:636-239-1650
Mailing Address - Fax:636-239-9005
Practice Address - Street 1:3454 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2533
Practice Address - Country:US
Practice Address - Phone:314-822-3776
Practice Address - Fax:314-822-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013275Medicare PIN