Individual
DR. EMMANUEL STEVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2645 N ILLINOIS ST, SWANSEA, IL 62226-2302
(618) 767-5100
Mailing address
15933 CLAYTON RD STE 210, BALLWIN, MO 63011-2172
(999) 999-9999
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.012080
IL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/14/2023
Last updated
04/08/2026
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