Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | IL |
NPI | 1477624120 |
---|---|
Provider Name | Dr. Alicia Ann Stovell |
First Address | Chicago, IL 60619 |
Second Address | Chicago, IL 60619-5665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1621812 | BLUECROSS PROVIDER NUMBER (01) | IL |
7739949440 | VSP .VISION PLAN (01) | IL |
BM3165099 | DEA NUMBER (01) | IL |
IL5099 | EYEMED VISION PLAN (01) | IL |
L63695 | (02) | IL |