Provider Demographics
NPI:1619955788
Name:DEAN, STEVEN K (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:K
Last Name:DEAN
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 1:1057 BROAD ST
Mailing Address - Street 2:JESSAMINE MALL
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2567
Mailing Address - Country:US
Mailing Address - Phone:803-775-7877
Mailing Address - Fax:803-934-0547
Practice Address - Street 1:1057 BROAD ST
Practice Address - Street 2:JESSAMINE MALL
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2567
Practice Address - Country:US
Practice Address - Phone:803-775-7877
Practice Address - Fax:803-934-0547
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1137152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD11379Medicaid