Provider Demographics
NPI:1912011727
Name:DEEN, STEVEN CALVIN (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CALVIN
Last Name:DEEN
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 1:12114 SIGILLARY WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6328
Mailing Address - Country:US
Mailing Address - Phone:317-840-9520
Mailing Address - Fax:
Practice Address - Street 1:1920 E MARKLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6236
Practice Address - Country:US
Practice Address - Phone:765-456-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002348152W00000X
IN18002348B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN366130Medicare ID - Type Unspecified
INU19675Medicare UPIN