Provider Demographics
NPI:1942236963
Name:STEVENER, RONALD C (OD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:C
Last Name:STEVENER
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 1:3323 S LOOP 256
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-6977
Mailing Address - Country:US
Mailing Address - Phone:903-729-6361
Mailing Address - Fax:903-723-1186
Practice Address - Street 1:3323 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6977
Practice Address - Country:US
Practice Address - Phone:903-729-6361
Practice Address - Fax:903-723-1186
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2762TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410039275OtherRR MCARE
TX1304970001OtherDMERC
TX11365OtherSUPERIOR HEALTH (CHIPS)
TX112465301Medicaid
TX82220NOtherBCBS
TX82220NMedicare ID - Type Unspecified
TX112465301Medicaid