Individual
STACEY R WENGER BOWLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T03303
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000006128
GROUP MEDICARE #
MO
01
—
115578
BLUE CROSS BLUE SHIELD
MO
05
—
318591302
—
MO
Enumeration date
12/06/2005
Last updated
09/15/2010
Update your record
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