Provider Demographics
NPI:1821253014
Name:DR. STEVEN A. FIRESTONE & ASSOCIATES
Entity Type:Organization
Organization Name:DR. STEVEN A. FIRESTONE & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FIRESTONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-449-2020
Mailing Address - Street 1:3652 ROME DR
Mailing Address - Street 2:SHENANDOAH CENTER
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4465
Mailing Address - Country:US
Mailing Address - Phone:765-449-2020
Mailing Address - Fax:765-447-5430
Practice Address - Street 1:3652 ROME DR
Practice Address - Street 2:SHENANDOAH CENTER
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4465
Practice Address - Country:US
Practice Address - Phone:765-449-2020
Practice Address - Fax:765-447-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ18001968B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1821253014Medicare PIN