Provider Demographics
NPI:1225196827
Name:STEWART, RICHARD SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
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 1:10006 W HAPPY VALLEY RD
Mailing Address - Street 2:#1250
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1235
Mailing Address - Country:US
Mailing Address - Phone:623-566-3937
Mailing Address - Fax:623-566-1840
Practice Address - Street 1:10006 W HAPPY VALLEY RD
Practice Address - Street 2:#1250
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1235
Practice Address - Country:US
Practice Address - Phone:623-566-3937
Practice Address - Fax:623-566-1840
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ410031687Medicare PIN
AZU24861Medicare UPIN
AZZ125917Medicare PIN