Provider Demographics
NPI:1164575395
Name:HARING, STEPHEN EDWARD (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EDWARD
Last Name:HARING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 STONEGATE CENTER
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63088
Mailing Address - Country:US
Mailing Address - Phone:636-225-9300
Mailing Address - Fax:636-225-4132
Practice Address - Street 1:23 STONEGATE CENTER
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63088
Practice Address - Country:US
Practice Address - Phone:636-225-9300
Practice Address - Fax:636-225-4132
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist