Individual
DR. TERESA L STICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
209 W WASHINGTON, VANDALIA, MO 63382
(573) 594-2525
(573) 594-3611
Mailing address
20660 ACR 306, MEXICO, MO 65265
(573) 581-8668
(573) 581-8850
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T03337
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
177427
BLUE CROSS BLUE SHIELD
—
01
—
2353629
UNITED HEALTH CARE
MO
01
—
318847217
HEALTHCARE USA
MO
05
—
318847217
—
MO
Enumeration date
11/10/2005
Last updated
02/25/2011
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