Provider Demographics
NPI:1497060701
Name:STEVENS, CLAUDE N
Entity Type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:N
Last Name:STEVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:CLAUDE
Other - Middle Name:N
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1804 S. E. ENSIGN LANE
Mailing Address - Street 2:OPTOMETRY
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146
Mailing Address - Country:US
Mailing Address - Phone:503-436-0541
Mailing Address - Fax:
Practice Address - Street 1:1804 SE ENSIGN LN
Practice Address - Street 2:OPTOMETRY
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-7339
Practice Address - Country:US
Practice Address - Phone:503-338-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1173AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117159Medicare PIN