Provider Demographics
NPI:1871583005
Name:STEPHENSON, DOUGLAS LEE (OD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:LEE
Last Name:STEPHENSON
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 1:13901 US HIGHWAY 1
Mailing Address - Street 2:SUITE 12
Mailing Address - City:JUNO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-1612
Mailing Address - Country:US
Mailing Address - Phone:561-627-6113
Mailing Address - Fax:561-627-6114
Practice Address - Street 1:13901 US HIGHWAY 1
Practice Address - Street 2:SUITE 12
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1612
Practice Address - Country:US
Practice Address - Phone:561-627-6113
Practice Address - Fax:561-627-6114
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1974152W00000X, 152WC0802X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0807780001Medicare NSC
FLT85246Medicare UPIN
FL19767Medicare ID - Type Unspecified