Provider Demographics
NPI:1144554171
Name:STEPHEN J. MEBRUER, O.D., L.L.C.
Entity type:Organization
Organization Name:STEPHEN J. MEBRUER, O.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MEBRUER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-342-5100
Mailing Address - Street 1:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65625-0834
Mailing Address - Country:US
Mailing Address - Phone:417-846-1062
Mailing Address - Fax:417-846-1065
Practice Address - Street 1:10340 FARM RD. 2176
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625
Practice Address - Country:US
Practice Address - Phone:417-846-1062
Practice Address - Fax:417-846-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03479152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty