Provider Demographics
NPI:1134434798
Name:STEWART, AARON DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:DAVID
Last Name:STEWART
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 1:2860 E BELTLINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9704
Mailing Address - Country:US
Mailing Address - Phone:616-364-8484
Mailing Address - Fax:616-364-9686
Practice Address - Street 1:2860 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9704
Practice Address - Country:US
Practice Address - Phone:616-364-8484
Practice Address - Fax:616-364-9686
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2019-10-29
Deactivation Date:2019-06-21
Deactivation Code:
Reactivation Date:2019-07-05
Provider Licenses
StateLicense IDTaxonomies
MI4901004571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN26930196Medicare PIN
MIN34040105Medicare PIN