Provider Demographics
NPI:1194845248
Name:STEWART, JAMES ALBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALBERT
Last Name:STEWART
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 1:6053 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1623
Mailing Address - Country:US
Mailing Address - Phone:559-437-0777
Mailing Address - Fax:559-437-0795
Practice Address - Street 1:6053 N PALM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1623
Practice Address - Country:US
Practice Address - Phone:559-437-0777
Practice Address - Fax:559-437-0795
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7582T152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD007582Medicaid
CASD007582Medicaid