Provider Demographics
NPI:1083831937
Name:STEPENSKY, JOHN G SR (LO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:G
Last Name:STEPENSKY
Suffix:SR
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-4007
Practice Address - Country:US
Practice Address - Phone:860-223-3973
Practice Address - Fax:860-223-3973
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000406156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT100000406CT01OtherBLUE CROSS BLUE SHIELD
CT133452OtherEYEMED
CT0271070001Medicare PIN