Provider Demographics
NPI:1982606695
Name:COLLIER, JANET L (OD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:L
Last Name:COLLIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:L
Other - Last Name:PROVENCAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15933 CLAYTON RD
Mailing Address - Street 2:STE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-938-2650
Practice Address - Street 1:730 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-5929
Practice Address - Country:US
Practice Address - Phone:314-821-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO318609823Medicaid
MO258866438Medicare PIN
MO318609823Medicaid
MOMA5227049Medicare UPIN