Provider Demographics
NPI:1083777429
Name:WARD, STEPHEN DOUGLAS (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:WARD
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 1:1407 N RACE ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3474
Mailing Address - Country:US
Mailing Address - Phone:270-651-6652
Mailing Address - Fax:270-651-9840
Practice Address - Street 1:1407 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3474
Practice Address - Country:US
Practice Address - Phone:270-651-6652
Practice Address - Fax:270-651-9840
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY841DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008415Medicaid
KYT78562Medicare UPIN
KY9150101Medicare ID - Type Unspecified
KY77008415Medicaid