Provider Demographics
NPI:1508878695
Name:STEBBINS, NATHAN C (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:C
Last Name:STEBBINS
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 1:200 S FINDLEY ST
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2048
Mailing Address - Country:US
Mailing Address - Phone:814-938-5920
Mailing Address - Fax:814-938-6926
Practice Address - Street 1:200 S FINDLEY ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2048
Practice Address - Country:US
Practice Address - Phone:814-938-5920
Practice Address - Fax:814-938-6926
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG01190PA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGATEWAYOther50430
PA001891449OtherBLUECROSS BLUE SHIELD
PARAILROAD MEDICAREOtherRAILROAD MEDICARE
PA397487OtherNVA NUMBER
PA1009134120001Medicaid
PAUMWAOtherUMW NUMBER
PASPECTRAOther27773
PA165781OtherMEDICARE PTAN
PA165781OtherMEDICARE PTAN
PA1009134120001Medicaid
PARAILROAD MEDICAREOtherRAILROAD MEDICARE