Individual
MARK A HAVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6663 EDWARDSVILLE CROSSING DR, STE B, EDWARDSVILLE, IL 62025-2704
(618) 659-2320
(618) 655-0375
Mailing address
40 E NORTH ST, EUREKA, MO 63025-1205
(636) 200-4393
(636) 938-2650
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010454
IL
Other
Enumeration date
08/11/2011
Last updated
10/02/2014
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