Provider Demographics
NPI:1306823497
Name:STEWARD, JAMES BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRIAN
Last Name:STEWARD
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 1:1259 A ST NE
Mailing Address - Street 2:STE 1
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-1601
Mailing Address - Country:US
Mailing Address - Phone:812-847-2020
Mailing Address - Fax:812-847-2020
Practice Address - Street 1:1259 A ST NE
Practice Address - Street 2:STE 1
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-1601
Practice Address - Country:US
Practice Address - Phone:812-847-2020
Practice Address - Fax:812-847-2020
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200519250Medicaid
INV05471Medicare UPIN
IN200519250Medicaid