Provider Demographics
NPI:1043467012
Name:STEVENS, WAYNE B (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:B
Last Name:STEVENS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-1177
Mailing Address - Country:US
Mailing Address - Phone:256-332-5440
Mailing Address - Fax:256-332-5402
Practice Address - Street 1:15255 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1924
Practice Address - Country:US
Practice Address - Phone:256-332-5440
Practice Address - Fax:256-332-5402
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-B82-TA-790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist