Provider Demographics
NPI:1992828834
Name:CANTRELL, STEVEN D (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:CANTRELL
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 1:7511 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2103
Mailing Address - Country:US
Mailing Address - Phone:314-961-7511
Mailing Address - Fax:314-961-6759
Practice Address - Street 1:7511 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2103
Practice Address - Country:US
Practice Address - Phone:314-961-7511
Practice Address - Fax:314-961-6759
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO 2222152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6300Medicare ID - Type Unspecified