MEDICARE: DOUG STEVENS

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	156FX1800X	Optician	768	AZ

General Provider Information

NPI Number	:	1750571006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUG STEVENS

Provider Business Mailing Address
First Line	:	10001 W BELL RD
Second Line	:	139
City	:	SUN CITY
State	:	AZ
Zip	:	85351-1282
Country	:	US
Telephone Number	:	623-815-1636
Fax Number	:	623-815-6778

Provider Business Practice Location Address
First Line	:	10001 W BELL RD
Second Line	:	139
City	:	SUN CITY
State	:	AZ
Zip	:	85351-1282
Country	:	US
Telephone Number	:	623-815-1636
Fax Number	:	623-815-6778

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	08/01/2007

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Directions to “ DOUG STEVENS ” Practice Location

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