Provider Demographics
NPI:1003805169
Name:STEPHEN, WILLIAM HENRY (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HENRY
Last Name:STEPHEN
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 1:5885 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4007
Mailing Address - Country:US
Mailing Address - Phone:813-908-0100
Mailing Address - Fax:813-908-0099
Practice Address - Street 1:5885 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4007
Practice Address - Country:US
Practice Address - Phone:813-908-0100
Practice Address - Fax:813-908-0099
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP2897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU69882Medicare UPIN
FL1246560001Medicare NSC
FLE0486Medicare ID - Type Unspecified