Provider Demographics
NPI:1346304508
Name:DAMON, STEVE W
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:W
Last Name:DAMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 S MAIN STREET RT 9
Mailing Address - Street 2:BUILDING 1B
Mailing Address - City:WEST CREEK
Mailing Address - State:NJ
Mailing Address - Zip Code:08092
Mailing Address - Country:US
Mailing Address - Phone:609-489-0040
Mailing Address - Fax:609-489-0041
Practice Address - Street 1:1064 S MAIN STREET RT 9
Practice Address - Street 2:BUILDING 1B
Practice Address - City:WEST CREEK
Practice Address - State:NJ
Practice Address - Zip Code:08092
Practice Address - Country:US
Practice Address - Phone:609-489-0040
Practice Address - Fax:609-489-0041
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1393156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0489110001Medicare ID - Type Unspecified