Healthcare Provider Details

I. General information

NPI: 1194717405
Provider Name (Legal Business Name): MICHAEL P STEELE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HIGHLANDS BOULEVARD DR
MANCHESTER MO
63011-4385
US

IV. Provider business mailing address

301 HIGHLANDS BOULEVARD DR
MANCHESTER MO
63011-4385
US

V. Phone/Fax

Practice location:
  • Phone: 636-686-7411
  • Fax:
Mailing address:
  • Phone: 636-686-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2004018280
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: