Provider Demographics
NPI:1750571006
Name:STEVENS, DOUG
Entity type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 W BELL RD
Mailing Address - Street 2:139
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-1282
Mailing Address - Country:US
Mailing Address - Phone:623-815-1636
Mailing Address - Fax:623-815-6778
Practice Address - Street 1:10001 W BELL RD
Practice Address - Street 2:139
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1282
Practice Address - Country:US
Practice Address - Phone:623-815-1636
Practice Address - Fax:623-815-6778
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ768156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1074650001Medicare PIN