Provider Demographics
NPI:1952304685
Name:STEPHENS, DONALD CHARLES III (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CHARLES
Last Name:STEPHENS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:518 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2117
Mailing Address - Country:US
Mailing Address - Phone:330-630-9699
Mailing Address - Fax:330-630-2173
Practice Address - Street 1:518 WEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2117
Practice Address - Country:US
Practice Address - Phone:330-630-9699
Practice Address - Fax:330-630-2173
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3628207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00191478OtherRAILROAD MEDICARE
OH2348372Medicaid
000000171260OtherUNISON
OH340976110DSOtherSUMMA
OH730481OtherBUCKEYE
OH000000354882OtherANTHEM
OH204862812OtherUNITED HEALTHCARE
341572960031OtherCARESOURCE
OH7949318OtherAETNA PPO