Provider Demographics
NPI:1326422155
Name:STEVENS EYECARE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:STEVENS EYECARE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-727-5237
Mailing Address - Street 1:205 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2821
Mailing Address - Country:US
Mailing Address - Phone:304-727-5237
Mailing Address - Fax:304-727-4051
Practice Address - Street 1:205 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2821
Practice Address - Country:US
Practice Address - Phone:304-727-5237
Practice Address - Fax:304-727-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV-1080-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV0297AOtherMEDICARE PTAN
1063724003OtherINDIVIDUAL NPI