Provider Demographics
NPI:1982635801
Name:STEVENS, HENRY W (OD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:W
Last Name:STEVENS
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 1:12559 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2522
Mailing Address - Country:US
Mailing Address - Phone:305-895-3423
Mailing Address - Fax:305-895-3472
Practice Address - Street 1:12559 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2522
Practice Address - Country:US
Practice Address - Phone:305-895-3423
Practice Address - Fax:305-895-3472
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1192 808 OPC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0485150001OtherDMERC
FL19757Medicare ID - Type Unspecified
FLT84059Medicare UPIN