Provider Demographics
NPI:1760660757
Name:STEPHEN V. MAURER
Entity Type:Organization
Organization Name:STEPHEN V. MAURER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-343-0145
Mailing Address - Street 1:163 W HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-3840
Mailing Address - Country:US
Mailing Address - Phone:330-343-0145
Mailing Address - Fax:330-343-1240
Practice Address - Street 1:163 W HIGH AVE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-3840
Practice Address - Country:US
Practice Address - Phone:330-343-0145
Practice Address - Fax:330-343-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3480261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0493180001Medicare NSC