Provider Demographics
NPI:1477624120
Name:STOVELL, ALICIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:ANN
Last Name:STOVELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8541 S. STATE ST.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619
Mailing Address - Country:US
Mailing Address - Phone:773-994-9440
Mailing Address - Fax:773-994-8166
Practice Address - Street 1:8541 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-5665
Practice Address - Country:US
Practice Address - Phone:773-994-9440
Practice Address - Fax:773-994-8166
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1621812OtherBLUECROSS PROVIDER NUMBER
IL7739949440OtherVSP .VISION PLAN
ILIL5099OtherEYEMED VISION PLAN
ILIL5099OtherEYEMED VISION PLAN
ILL63695Medicare UPIN
ILBM3165099OtherDEA NUMBER