Molly June Stacks, OD

NPI #1164126793 in Edwardsville, Illinois

Provider Information

NPI Number: 1164126793
Entity Type: Individual
Name: Molly June Stacks, OD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Optometrist
Credential: OD
Enumeration Date: Mar 28, 2023
Last Updated: Mar 11, 2024

Practice Location

Address: 2121 S STATE ROUTE 157
City: Edwardsville
State: Illinois
ZIP Code: 62025-3691
Phone: (618) 656-7774

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X
Optometrist	152W00000X	Primary

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