Provider Demographics
NPI:1619935038
Name:DAVENPORT, STEVEN CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHARLES
Last Name:DAVENPORT
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 1:4511 SWEETWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3010
Mailing Address - Country:US
Mailing Address - Phone:281-265-2020
Mailing Address - Fax:281-265-2029
Practice Address - Street 1:4511 SWEETWATER BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3010
Practice Address - Country:US
Practice Address - Phone:281-265-2020
Practice Address - Fax:281-265-2029
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4451TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX59RNOtherBCBS
TX59RNOtherBCBS
TX6241700001Medicare NSC