Provider Demographics
NPI:1861578643
Name:STICKEL, THOMAS ERIC (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ERIC
Last Name:STICKEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N HWY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031
Mailing Address - Country:US
Mailing Address - Phone:314-838-0300
Mailing Address - Fax:314-838-4682
Practice Address - Street 1:900 N HWY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031
Practice Address - Country:US
Practice Address - Phone:314-838-0300
Practice Address - Fax:314-838-4682
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001025242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7442309OtherAETNA
33666OtherCOORDINATED VISION CARE
111777OtherMERCY HEALTH PLANS
2141308OtherUNITED HEALTHCARE
24942OtherOPTICARE EYE HLTH NETWORK
103480OtherGROUP HEALTH PLAN
475940OtherHEALTHLINK
167299OtherEYEMED VISION CARE
154765OtherBCBS
475940OtherHEALTHLINK