Provider Demographics
NPI:1477715399
Name:STEVENS, LYNNE SANDERS (OD)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:SANDERS
Last Name:STEVENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4053 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5029
Mailing Address - Country:US
Mailing Address - Phone:205-382-1041
Mailing Address - Fax:
Practice Address - Street 1:833 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 401
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1606
Practice Address - Country:US
Practice Address - Phone:205-933-7932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-B94-TA-803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00841079OtherRAILROAD MEDICARE
MS08028715OtherMEDICAID OF MISSISSIPPI
AL110054Medicaid
AL51598019OtherBCBS
AL102I414871Medicare PIN