Provider Demographics
NPI:1982665527
Name:STROM, STEVEN NEAL (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:NEAL
Last Name:STROM
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 1:201 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767
Mailing Address - Country:US
Mailing Address - Phone:631-361-5116
Mailing Address - Fax:718-278-3865
Practice Address - Street 1:22-38 31 STREET
Practice Address - Street 2:ODYSSEY OPTICAL INC
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105
Practice Address - Country:US
Practice Address - Phone:718-278-3600
Practice Address - Fax:718-278-3865
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV00031381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00345620Medicaid
NY00345620Medicaid
NY0627510001Medicare ID - Type Unspecified