Provider Demographics
NPI:1982668208
Name:POWELL, STEPHEN V (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:V
Last Name:POWELL
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 1:8216 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1641
Mailing Address - Country:US
Mailing Address - Phone:937-454-2020
Mailing Address - Fax:937-454-2024
Practice Address - Street 1:8216 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1641
Practice Address - Country:US
Practice Address - Phone:937-454-2020
Practice Address - Fax:937-454-2024
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0300221Medicaid
T46768Medicare UPIN
OHPO0417163Medicare PIN
OH0673360001Medicare NSC