Provider Demographics
NPI:1649293192
Name:WOLFE, STEWART I (O,D)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:I
Last Name:WOLFE
Suffix:
Gender:M
Credentials:O,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4421
Mailing Address - Country:US
Mailing Address - Phone:707-575-3800
Mailing Address - Fax:707-528-4967
Practice Address - Street 1:720 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4421
Practice Address - Country:US
Practice Address - Phone:707-557-3800
Practice Address - Fax:707-528-4967
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7090152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0070900Medicare ID - Type Unspecified