Provider Demographics
NPI:1811998503
Name:HLIS, STEPHEN G (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:HLIS
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:PO BOX 1915
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-1915
Mailing Address - Country:US
Mailing Address - Phone:325-643-9336
Mailing Address - Fax:
Practice Address - Street 1:401 W COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-1701
Practice Address - Country:US
Practice Address - Phone:325-643-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4986TG152WS0006X, 152WX0102X, 152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5815OtherINDIVIDUAL & GROUP PTAN
TX0930836-01Medicaid
TX00087SMedicare ID - Type Unspecified
TXU50682Medicare UPIN