Provider Demographics
NPI:1003921529
Name:STEWART, MICHAEL JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:STEWART
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3046 LAVON DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-8794
Mailing Address - Country:US
Mailing Address - Phone:972-495-8998
Mailing Address - Fax:972-496-1535
Practice Address - Street 1:3046 LAVON DR
Practice Address - Street 2:SUITE 130
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-8794
Practice Address - Country:US
Practice Address - Phone:972-495-8998
Practice Address - Fax:972-496-1535
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX61891T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist