Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 2002015335 | MO |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2002015335 | MO |
NPI | 1235224676 |
---|---|
Provider Name | Dr. Rebecca J. Stilley |
First Address | Joplin, MO 64804 |
Second Address | Joplin, MO 64804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 19/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U90659 | (02) | MO |