Provider Demographics
NPI:1154456630
Name:FIRESTONE, STEVEN A (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:FIRESTONE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1221 S CREASY LN
Mailing Address - Street 2:STE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-7430
Mailing Address - Country:US
Mailing Address - Phone:765-447-4951
Mailing Address - Fax:765-447-4834
Practice Address - Street 1:1221 S CREASY LN STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-7430
Practice Address - Country:US
Practice Address - Phone:765-447-4951
Practice Address - Fax:765-447-4834
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN18001968B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154456630Medicare UPIN