Provider Demographics
NPI:1144263963
Name:STEBEL, TODD A (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:STEBEL
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 1:13075 PERSIMMON LN SUITE A
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713
Mailing Address - Country:US
Mailing Address - Phone:208-938-9900
Mailing Address - Fax:208-939-9264
Practice Address - Street 1:13075 PERSIMMON LN SUITE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713
Practice Address - Country:US
Practice Address - Phone:208-938-9900
Practice Address - Fax:208-939-9264
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-1022152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID40858OtherDAVIS VISION PIN
ID8N117OtherBLUE CROSS OF IDAHO GROUP
IDV7323OtherBLUE CROSS OF IDAHO
IDV5061OtherBLUECROSS OF IDAHO
ID1902007263OtherGROUP NPI
ID298349OtherALTIUS
ID000010137319OtherREGENCE BLUE SHIELD OF ID
IDV7323OtherBLUE CROSS OF IDAHO
ID40858OtherDAVIS VISION PIN
ID8N117OtherBLUE CROSS OF IDAHO GROUP
ID4605460001Medicare NSC