Healthcare Provider Details

I. General information

NPI: 1891757704
Provider Name (Legal Business Name): STEPHEN T CAUBLE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 CENTRAL AVE
DODGE CITY KS
67801-6206
US

IV. Provider business mailing address

1000 S 169 HWY
SMITHVILLE MO
64089-9322
US

V. Phone/Fax

Practice location:
  • Phone: 620-227-2471
  • Fax: 816-817-1519
Mailing address:
  • Phone: 888-749-7755
  • Fax: 816-817-1519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1116-2
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1116-3
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: