Healthcare Provider Details

I. General information

NPI: 1083096523
Provider Name (Legal Business Name): COURTNEY ANNE STEHLIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2015
Last Update Date: 06/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S COUNTY CENTER WAY
SAINT LOUIS MO
63129-1092
US

IV. Provider business mailing address

38 WASHINGTON TER
SAINT LOUIS MO
63112-1914
US

V. Phone/Fax

Practice location:
  • Phone: 314-416-7588
  • Fax:
Mailing address:
  • Phone: 217-725-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2015019903
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: