Provider Demographics
NPI:1720089964
Name:CORWIN, STEVEN R (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:CORWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:351 ROLLING OAKS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1279
Mailing Address - Country:US
Mailing Address - Phone:805-497-3744
Mailing Address - Fax:805-497-1663
Practice Address - Street 1:351 ROLLING OAKS DR STE 102
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1279
Practice Address - Country:US
Practice Address - Phone:805-497-3744
Practice Address - Fax:805-497-1663
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG139740207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000393115DMedicaid
GA18BDFLPMedicare ID - Type Unspecified