Provider Demographics
NPI:1508920349
Name:STEVENS, JAMES M (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:STEVENS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2407 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-3166
Mailing Address - Country:US
Mailing Address - Phone:815-439-3064
Mailing Address - Fax:815-439-3882
Practice Address - Street 1:1601 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-4303
Practice Address - Country:US
Practice Address - Phone:773-836-4110
Practice Address - Fax:773-637-1109
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL046-007603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL183477Medicare UPIN