Provider Demographics
NPI:1598825184
Name:STEPHENS, AMY M (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:STE 520
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:850-893-4005
Mailing Address - Fax:850-894-5462
Practice Address - Street 1:15196 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-4820
Practice Address - Country:US
Practice Address - Phone:229-228-4770
Practice Address - Fax:229-225-9060
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3179152W00000X
GA001621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620388400Medicaid
FL20842OtherBLUR CROSS BLUE SHIELD
FL410037564OtherRAILROAD MEDICARE
GA00825833AMedicaid
GA41ZCDHPMedicare ID - Type Unspecified
GA00825833AMedicaid
FLU69208Medicare UPIN