Provider Demographics
NPI:1518440817
Name:HERMAN, STEPHEN (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:HERMAN
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 1:2822 VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-8631
Mailing Address - Country:US
Mailing Address - Phone:906-228-4401
Mailing Address - Fax:906-225-0460
Practice Address - Street 1:2822 VENTURE DR
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-8631
Practice Address - Country:US
Practice Address - Phone:906-228-4401
Practice Address - Fax:906-225-0460
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005160152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist