Provider Demographics
NPI:1891817573
Name:AMY M. STEPHENS, O.D., P.A.
Entity Type:Organization
Organization Name:AMY M. STEPHENS, O.D., P.A.
Other - Org Name:EYE SAVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:229-228-4770
Mailing Address - Street 1:1480 TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1713
Mailing Address - Country:US
Mailing Address - Phone:850-894-2332
Mailing Address - Fax:850-668-8625
Practice Address - Street 1:15196 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-4820
Practice Address - Country:US
Practice Address - Phone:229-228-4770
Practice Address - Fax:229-225-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00825833AMedicaid
GA07566OtherSPECTERA
GA44253OtherAVESIS-GROUP
GA92033OtherAVESIS MEDICAID
GA07566OtherSPECTERA
GA0811840001Medicare NSC