Provider Demographics
NPI:1659376853
Name:STUEVER, WILLIAM A (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:STUEVER
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 1:1619 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2703
Mailing Address - Country:US
Mailing Address - Phone:580-762-5700
Mailing Address - Fax:580-765-3022
Practice Address - Street 1:1619 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2703
Practice Address - Country:US
Practice Address - Phone:580-762-5700
Practice Address - Fax:580-765-3022
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2144152W00000X
OKOK2144152WC0802X, 152WL0500X, 152WS0006X, 152WX0102X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761130AMedicaid
OK100761130AMedicaid
OKU51310Medicare UPIN
OKOK404246Medicare PIN