Provider Demographics
NPI:1649405218
Name:SOBIERALSKI, BRETT ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALAN
Last Name:SOBIERALSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15933 CLAYTON RD,
Mailing Address - Street 2:STE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:2525 GREEN MOUNT COMMONS DR
Practice Address - Street 2:STE 290
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-6724
Practice Address - Country:US
Practice Address - Phone:618-233-7800
Practice Address - Fax:618-233-7290
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009017112152W00000X
IL046010245152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210906004Medicare PIN
IL0360070029Medicare NSC