Provider Demographics
NPI:1235206939
Name:SAMPSON, STEVEN F (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:F
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:F
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTOMETRIST
Mailing Address - Street 1:4404 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0889
Mailing Address - Country:US
Mailing Address - Phone:812-474-0006
Mailing Address - Fax:812-474-1851
Practice Address - Street 1:4404 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0889
Practice Address - Country:US
Practice Address - Phone:812-474-0006
Practice Address - Fax:812-474-1851
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ 1835152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100247370AMedicaid
IN847890Medicare PIN
IN100247370AMedicaid
INT35096Medicare UPIN
IN410010531Medicare PIN