Individual
MR. STEFAN M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
724 ST. LOUIS ROAD, COLLINSVILLE, IL 62234-2032
(618) 345-0210
(618) 345-4770
Mailing address
724 ST. LOUIS ROAD, COLLINSVILLE, IL 62234-2032
(618) 345-0210
(618) 345-4770
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046.010136
IL
152W00000X
Optometrist
Primary
046010136
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010136
—
IL
Enumeration date
08/01/2008
Last updated
11/02/2009
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