MEDICARE: DR. BRETT ALAN SOBIERALSKI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2009017112	MO
2	152W00000X	Optometrist	046010245	IL

General Provider Information

NPI Number	:	1649405218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT ALAN SOBIERALSKI O.D.

Provider Business Mailing Address
First Line	:	15933 CLAYTON RD,
Second Line	:	STE 201
City	:	BALLWIN
State	:	MO
Zip	:	63011-2172
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	2525 GREEN MOUNT COMMONS DR
Second Line	:	STE 290
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-6724
Country	:	US
Telephone Number	:	618-233-7800
Fax Number	:	618-233-7290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	01/05/2026

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