Provider Demographics
NPI:1932267051
Name:STEVENS, SEAN MICHEAL (OD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHEAL
Last Name:STEVENS
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 1:433 SE MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2651
Mailing Address - Country:US
Mailing Address - Phone:864-963-4933
Mailing Address - Fax:864-967-7020
Practice Address - Street 1:309 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2653
Practice Address - Country:US
Practice Address - Phone:864-963-4933
Practice Address - Fax:864-967-7020
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1285152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD12859Medicaid
SCU97330Medicare UPIN
SCD12859Medicaid