Healthcare Provider Details

I. General information

NPI: 1164575395
Provider Name (Legal Business Name): STEPHEN EDWARD HARING O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 STONEGATE CENTER
MANCHESTER MO
63088
US

IV. Provider business mailing address

23 STONEGATE CENTER
MANCHESTER MO
63088
US

V. Phone/Fax

Practice location:
  • Phone: 636-225-9300
  • Fax: 636-225-4132
Mailing address:
  • Phone: 636-225-9300
  • Fax: 636-225-4132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02872
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: