Provider Demographics
NPI:1972758670
Name:PONCIANO, STEVE
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:
Last Name:PONCIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W FM 1382
Mailing Address - Street 2:STE.150
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2164
Mailing Address - Country:US
Mailing Address - Phone:972-293-6444
Mailing Address - Fax:972-293-6447
Practice Address - Street 1:140 W FM 1382
Practice Address - Street 2:STE.150
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2164
Practice Address - Country:US
Practice Address - Phone:972-293-6444
Practice Address - Fax:972-293-6447
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician