Provider Demographics
NPI:1528447174
Name:EVANS, CAMERON JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:JOSEPH
Last Name:EVANS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 INSIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2146
Mailing Address - Country:US
Mailing Address - Phone:618-391-1660
Mailing Address - Fax:618-861-6003
Practice Address - Street 1:705 INSIGHT AVE
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2146
Practice Address - Country:US
Practice Address - Phone:618-391-1660
Practice Address - Fax:618-861-6003
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023029272207W00000X
IL036.165041207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology