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General NPI Number Information
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NPI Number | 1366966186
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Entity Type | Organization
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Legal Business Name | IDEAL EYE SURGERY LLC
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 705 INSIGHT AVE
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City | O FALLON
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State | IL
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Zip | 62269-2146
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Country | US
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Telephone | 618-391-1660
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Fax | 618-861-6003
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Provider Business Mailing Address
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Address Line | 705 INSIGHT AVE
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City | O FALLON
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State | IL
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Zip | 62269-2146
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Country | US
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Telephone | 618-391-1660
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Fax | 618-861-6003
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL VINCENT STOCK
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Credential | M.D.
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Telephone | 618-391-1660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036.141217
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License Number State | IL
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