Provider Demographics
NPI:1780948893
Name:STEVENSON, EDWARD (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5755 MARK DABLING BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2270
Mailing Address - Country:US
Mailing Address - Phone:719-257-3959
Mailing Address - Fax:719-934-9657
Practice Address - Street 1:5755 MARK DABLING BLVD STE 190
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2228
Practice Address - Country:US
Practice Address - Phone:719-257-3959
Practice Address - Fax:719-257-3959
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0058524207W00000X
CO58524207WX0107X, 207WX0108X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist