Provider Demographics
NPI:1457303729
Name:TAYLOR, STEPHEN MARK (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARK
Last Name:TAYLOR
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 1:50 STANIFORD ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-367-4800
Mailing Address - Fax:617-723-7028
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 600
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-367-4800
Practice Address - Fax:617-723-7028
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002385152W00000X
MA4563152W00000X
MA3864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004141230Medicaid
MA110074546AMedicaid
CT410000744Medicare ID - Type Unspecified
U56812Medicare UPIN
MAVX1519Medicare PIN