Individual
DR. MICHAEL F. STAUDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2980 N MAIN ST, SUITE 1, DECATUR, IL 62526
(217) 872-7200
(217) 872-0920
Mailing address
2980 N MAIN ST, SUITE 1, DECATUR, IL 62526-3291
(217) 872-7200
(217) 872-0920
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007191
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007131
—
IL
01
—
05821564
BLUE CROSS BLUE SHIELD
—
01
—
1864F
CATERPILLAR
IL
Enumeration date
01/16/2007
Last updated
06/19/2018
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