Healthcare Provider Details

I. General information

NPI: 1588967889
Provider Name (Legal Business Name): STEVEN LAWRENCE PLAXCO JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GENERAL LEONARD WOOD COMMUNITY HOSPITAL 4234 ILLINOIS AV
FORT LEONARD WOOD MO
65473-9098
US

IV. Provider business mailing address

GENERAL LEONARD WOOD COMMUNITY HOSPITAL 4234 ILLINOIS AV
FORT LEONARD WOOD MO
65473-9098
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-0048
  • Fax: 910-907-6069
Mailing address:
  • Phone: 573-596-0048
  • Fax: 910-907-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0620000098
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: