Provider Demographics
NPI:1508219080
Name:STEVENS, ASHLEY JADENE (OD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JADENE
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 1:279 STATION AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-1842
Mailing Address - Country:US
Mailing Address - Phone:508-398-6333
Mailing Address - Fax:
Practice Address - Street 1:279 STATION AVE
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1842
Practice Address - Country:US
Practice Address - Phone:508-398-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist