Healthcare Provider Details

I. General information

NPI: 1447353602
Provider Name (Legal Business Name): STEPHEN JOSEPH MEBRUER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10340 FARM RD. 2176
CASSVILLE MO
65625
US

IV. Provider business mailing address

PO BOX 834
CASSVILLE MO
65625-0834
US

V. Phone/Fax

Practice location:
  • Phone: 417-846-1062
  • Fax: 417-846-1065
Mailing address:
  • Phone: 417-342-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT03479
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: