Provider Demographics
NPI:1578771218
Name:MCLENDON, STEPHEN J (OPT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:J
Last Name:MCLENDON
Suffix:
Gender:M
Credentials:OPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 ANA DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1759
Mailing Address - Country:US
Mailing Address - Phone:256-718-6002
Mailing Address - Fax:256-718-6026
Practice Address - Street 1:178 ANA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1759
Practice Address - Country:US
Practice Address - Phone:256-718-6002
Practice Address - Fax:256-718-6026
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1467593921OtherJODYGROUP NPI
AL1902951775OtherNPI MEDICARE