Mark A Havera, OD
Optometrist in Edwardsville, IL. Individual provider (NPI-1).
NPI number1306125166
StatusActive
Last updated in NPPESOct 2, 2014
Details
- NPI
- 1306125166
- Entity type
- Individual (NPI-1)
- Name
- Mark A Havera
- Credential
- OD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 11, 2011
- Last updated
- Oct 2, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 046010454 | IL | Yes |
Practice location
6663 Edwardsville Crossing DrSte B
Edwardsville, IL 62025-2704
Phone 618-659-2320 · Fax 618-655-0375
Mailing address
40 E North StEureka, MO 63025-1205
Phone 636-200-4393 · Fax 636-938-2650
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All 20 Optometrist providers in Edwardsville · All 899 providers in Edwardsville
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