Stefan M Smith, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010136 Issued in IL

Practice address

724 St. Louis Road
Collinsville, IL 62234-2032

Phone

(618) 345-0210

Fax

(618) 345-4770

NPI assigned

Aug 1, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL, CO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vep Il Optometric LLCGroup PAC ID 3678814217, 27 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vep Il Optometric LLC

  • Optometrist
  • Bloomington, IL
  • NPI 1528536620

  IL, Optometrist

  Medicare reassignment Care Compare group NPD
• Eye Center of the Rockies PC

  • Specialist
  • Longmont, CO
  • NPI 1205077799
  NPD
• James F. Strieter, OD, PC

  • Optometrist
  • Collinsville, IL
  • NPI 1851304539
  NPD (past)
• Oneopto Il 2 PLLC

  • Optometrist
  • Bloomington, IL
  • NPI 1003788431
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257120000000",
    "number": "1932365699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 ST. LOUIS ROAD",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622342032",
            "telephone_number": "618-345-0210",
            "fax_number": "618-345-4770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 ST. LOUIS ROAD",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622342032",
            "telephone_number": "618-345-0210",
            "fax_number": "618-345-4770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "STEFAN",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-01",
        "last_updated": "2009-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.010136",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046010136",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sincere Medical Service
• Natalie Rae Sipole
• Danielle Sircle
• Judy P Sledge, LCPC CEAP
• Michael Sly
• Steven Scott Smith, RPH.
• Susan M Smith, DC
• Southern Illinois Health Care Association
• Southern Illinois Healthcare Foundation Inc
• Southern Illinois Healthcare Foundation, Inc.

• All providers in Collinsville, IL
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.