Provider Demographics
NPI:1508074006
Name:STEIDLEY, TREVOR LEE (OD)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:LEE
Last Name:STEIDLEY
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 1:100 N D ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3621
Mailing Address - Country:US
Mailing Address - Phone:775-750-1362
Mailing Address - Fax:
Practice Address - Street 1:100 N D ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3621
Practice Address - Country:US
Practice Address - Phone:775-750-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10806TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP606ZMedicare PIN