Provider Demographics
NPI:1861457657
Name:MAXWELL, STEVEN JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOHN
Last Name:MAXWELL
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 1:9517 ROUTE 52 S
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-9546
Mailing Address - Country:US
Mailing Address - Phone:563-588-2561
Mailing Address - Fax:
Practice Address - Street 1:1950 JFK RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-3897
Practice Address - Country:US
Practice Address - Phone:563-585-2020
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1839152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0231241Medicaid
IA0231241Medicaid
IAT01323Medicare UPIN