Provider Demographics
NPI:1578566386
Name:STEWART, DAVID K (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:STEWART
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3351 DAYTON XENIA RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2763
Mailing Address - Country:US
Mailing Address - Phone:937-429-0266
Mailing Address - Fax:937-429-9022
Practice Address - Street 1:3351 DAYTON XENIA RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2763
Practice Address - Country:US
Practice Address - Phone:937-429-0266
Practice Address - Fax:937-429-9022
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217894Medicaid
OH0217894Medicaid
OH0392851Medicare PIN
OH0132700001Medicare NSC