Provider Demographics
NPI:1346245123
Name:FOLLANSBEE, STEVEN L (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:FOLLANSBEE
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 1:123 VILLAGE CENTER DRIVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LORDS VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-9098
Mailing Address - Country:US
Mailing Address - Phone:570-775-7675
Mailing Address - Fax:570-775-7974
Practice Address - Street 1:123 VILLAGE CENTER DR
Practice Address - Street 2:SUITE 11
Practice Address - City:LORDS VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-6134
Practice Address - Country:US
Practice Address - Phone:570-775-7675
Practice Address - Fax:570-775-7974
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000076152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039863Medicare PIN
PAFO039863Medicare ID - Type UnspecifiedMEDICARE
PA5280440001Medicare NSC
PAU81208Medicare UPIN