Provider Demographics
NPI:1063462810
Name:DEWEY, STEVEN CHARLES (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CHARLES
Last Name:DEWEY
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 1:5800 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5327
Mailing Address - Country:US
Mailing Address - Phone:801-964-1300
Mailing Address - Fax:801-964-1300
Practice Address - Street 1:5800 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5327
Practice Address - Country:US
Practice Address - Phone:801-964-1300
Practice Address - Fax:801-964-1300
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1132329934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT203606109024Medicaid
UT203606109016Medicaid
UT000009298Medicare ID - Type Unspecified
UT203606109016Medicaid