Provider Demographics
NPI:1114904588
Name:STEWART FAMILY EYE CARE PC
Entity Type:Organization
Organization Name:STEWART FAMILY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-947-2020
Mailing Address - Street 1:601 S GARFIELD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-5501
Mailing Address - Country:US
Mailing Address - Phone:231-947-2020
Mailing Address - Fax:231-947-2002
Practice Address - Street 1:601 S GARFIELD AVE
Practice Address - Street 2:STE A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-5501
Practice Address - Country:US
Practice Address - Phone:231-947-2020
Practice Address - Fax:231-947-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004160152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944697888Medicaid
MIVO3010Medicare UPIN
MI0P07130Medicare PIN