Provider Demographics
NPI:1851389423
Name:MACDONALD, STEVEN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:MACDONALD
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 1:2500 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4412
Mailing Address - Country:US
Mailing Address - Phone:850-784-3937
Mailing Address - Fax:
Practice Address - Street 1:2500 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4412
Practice Address - Country:US
Practice Address - Phone:850-784-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1048152W00000X
MO2007034505152W00000X
KS1942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS406B00017OtherMEDICARE
MOP01156991OtherRAILROAD MEDICARE PTAN
MO406000017OtherMEDICARE PTAN
MO406000017OtherMEDICARE PTAN