Provider Demographics
NPI:1346558012
Name:BALLARD, STEVEN RILEY (ABOC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:RILEY
Last Name:BALLARD
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73885 HIGHWAY 111
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4027
Mailing Address - Country:US
Mailing Address - Phone:303-919-2303
Mailing Address - Fax:
Practice Address - Street 1:73885 HIGHWAY 111
Practice Address - Street 2:SUITE 9
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4027
Practice Address - Country:US
Practice Address - Phone:303-244-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160688156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA160688OtherAMERICAN BOARD OF OPTICIANS