Provider Demographics
NPI:1902000466
Name:STILLEY EYE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:STILLEY EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O.D./SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-553-9903
Mailing Address - Street 1:1602 S RANGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3231
Mailing Address - Country:US
Mailing Address - Phone:417-553-9903
Mailing Address - Fax:417-627-9891
Practice Address - Street 1:1602 S RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3231
Practice Address - Country:US
Practice Address - Phone:417-553-9903
Practice Address - Fax:417-627-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002015335152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001742Medicare ID - Type UnspecifiedGROUP MEDICARE