Provider Demographics
NPI:1912180779
Name:ANNE E STEVENSON, O.D., P.A.
Entity Type:Organization
Organization Name:ANNE E STEVENSON, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-348-9500
Mailing Address - Street 1:7475 SKILLMAN ST
Mailing Address - Street 2:STE. 100B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-8314
Mailing Address - Country:US
Mailing Address - Phone:214-348-9500
Mailing Address - Fax:214-348-9501
Practice Address - Street 1:7475 SKILLMAN ST
Practice Address - Street 2:STE. 100B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8314
Practice Address - Country:US
Practice Address - Phone:214-348-9500
Practice Address - Fax:214-348-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3584T261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT16117Medicare UPIN
TX00Y288Medicare PIN