Provider Demographics
NPI:1982638508
Name:STEPHENSON, CHRISTOPHER WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:STEPHENSON
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 1:4521 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-660-0191
Mailing Address - Fax:706-596-8388
Practice Address - Street 1:4521 17TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-660-0191
Practice Address - Fax:706-596-8388
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001916152W00000X, 152WC0802X, 152WX0102X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2536269OtherUNITED HEALTHCARE
GAOPT001916OtherLICENSE
GA255363535BMedicaid
GA255363535BMedicaid
GADEAOtherMS0878605
GA255363535BMedicaid