Provider Demographics
NPI:1730442500
Name:STOCK, MICHAEL VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:STOCK
Suffix:
Gender:M
Credentials:MD
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:2012-06-18
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016004847207W00000X
MO2012018834207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200055492Medicaid