MEDICARE: STEPHEN CHARLES HUNTER O. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	ODP-932	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285748772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN CHARLES HUNTER O. D.

Provider Business Mailing Address
First Line	:	10454 W OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1433
Country	:	US
Telephone Number	:	208-672-1370
Fax Number	:

Provider Business Practice Location Address
First Line	:	10454 W OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1433
Country	:	US
Telephone Number	:	208-672-1370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	05/20/2010

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