Provider Demographics
NPI:1205982113
Name:DECKER, STEVEN DUANE (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DUANE
Last Name:DECKER
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 1:485 E MAIN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2162
Mailing Address - Country:US
Mailing Address - Phone:541-482-0552
Mailing Address - Fax:
Practice Address - Street 1:485 E MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2162
Practice Address - Country:US
Practice Address - Phone:541-482-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2560T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR293103Medicaid
OR293103Medicaid
ORR103660Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID