Healthcare Provider Details

I. General information

NPI: 1871087817
Provider Name (Legal Business Name): VICTORIA MARGARET STEWART OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 HIGHWAY K
O FALLON MO
63368-7861
US

IV. Provider business mailing address

PO BOX 207158
DALLAS TX
75320-7158
US

V. Phone/Fax

Practice location:
  • Phone: 636-240-1516
  • Fax:
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2018017136
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: