Provider Demographics
NPI:1356430631
Name:COMBS, STEPHEN M (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:COMBS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 S SUTTON RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-3367
Mailing Address - Country:US
Mailing Address - Phone:630-837-8300
Mailing Address - Fax:630-837-9146
Practice Address - Street 1:75 S SUTTON RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-3367
Practice Address - Country:US
Practice Address - Phone:630-837-8300
Practice Address - Fax:630-837-9146
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01620245OtherBCBS IL
IL0467360001OtherASF
IL0467360001OtherASF