MEDICARE: DR. KELSIE STEVENS OD

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	OPT-002450	AZ

General Provider Information

NPI Number	:	1689283830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELSIE STEVENS OD

Provider Business Mailing Address
First Line	:	3015 N SCOTTSDALE RD UNIT 4102
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7253
Country	:	US
Telephone Number	:	860-690-0948
Fax Number	:

Provider Business Practice Location Address
First Line	:	6815 N 19TH AVE STE 130
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1135
Country	:	US
Telephone Number	:	602-242-5293
Fax Number	:

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

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/23/2020

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