Provider Demographics
NPI:1033396569
Name:JOHN STEPENSKY
Entity Type:Organization
Organization Name:JOHN STEPENSKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LO
Authorized Official - Phone:860-223-3973
Mailing Address - Street 1:513 SOUTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051
Mailing Address - Country:US
Mailing Address - Phone:860-223-3973
Mailing Address - Fax:860-223-3973
Practice Address - Street 1:513 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051
Practice Address - Country:US
Practice Address - Phone:860-223-3973
Practice Address - Fax:860-223-3973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT100000406CT01OtherBLUE CROSS BLUE SHIELD
CT133452OtherEYEMED
CT133452OtherEYEMED