Provider Demographics
NPI:1023202140
Name:NEVETT, STEPHEN D (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:NEVETT
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 1:401 NE NORTHGATE WAY SPC 1101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8538
Mailing Address - Country:US
Mailing Address - Phone:206-364-2273
Mailing Address - Fax:206-364-2576
Practice Address - Street 1:401 NE NORTHGATE WAY SPC 1101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8538
Practice Address - Country:US
Practice Address - Phone:206-364-2273
Practice Address - Fax:206-364-2576
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2753ATI152W00000X
TX6000TG152W00000X
WA60060955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2075593Medicaid