Provider Demographics
NPI:1528220670
Name:SETCHELL, STACIE L (OD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:L
Last Name:SETCHELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:IL
Mailing Address - Zip Code:61270-2854
Mailing Address - Country:US
Mailing Address - Phone:815-772-7455
Mailing Address - Fax:
Practice Address - Street 1:201 E MARKET ST
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:IL
Practice Address - Zip Code:61270-2854
Practice Address - Country:US
Practice Address - Phone:815-772-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR02159Medicare UPIN