Individual
PAUL B STAUDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 E DELAWARE ST, SUITE C, FAIRFIELD, IL 62837-2111
(618) 842-6516
Mailing address
PO BOX 506, FAIRFIELD, IL 62837-0506
(618) 842-6516
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009085
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009085
—
IL
Enumeration date
10/10/2006
Last updated
02/20/2009
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