Provider Demographics
NPI:1790764702
Name:STEWART, JEFFREY SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:STEWART
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 1:15840 MEDICAL DRIVE SOUTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840
Mailing Address - Country:US
Mailing Address - Phone:419-422-6190
Mailing Address - Fax:419-423-3235
Practice Address - Street 1:15840 MEDICAL DRIVE SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840
Practice Address - Country:US
Practice Address - Phone:419-422-6190
Practice Address - Fax:419-423-3235
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0420217Medicaid
OH000000129593OtherANTHEM BCBS
OH410041112OtherRR MEDICARE
OH3442OtherSTATE LICENSE
OH4604154OtherAETNA
OHT670OtherDEA
OHT670OtherDEA
OH0420217Medicaid
OH3442OtherSTATE LICENSE