Provider Demographics
NPI:1891757704
Name:CAUBLE, STEPHEN T (OD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:T
Last Name:CAUBLE
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 1:1000 S 169 HWY
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64089-9322
Mailing Address - Country:US
Mailing Address - Phone:888-749-7755
Mailing Address - Fax:816-817-1519
Practice Address - Street 1:2405 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6206
Practice Address - Country:US
Practice Address - Phone:620-227-2471
Practice Address - Fax:816-817-1519
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1116-2152W00000X
KS1116-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100090280AMedicaid
KS651008Medicare ID - Type Unspecified
KS100090280AMedicaid