Healthcare Provider Details

I. General information

NPI: 1194845248
Provider Name (Legal Business Name): JAMES ALBERT STEWART O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6053 N PALM AVE
FRESNO CA
93704-1623
US

IV. Provider business mailing address

6053 N PALM AVE
FRESNO CA
93704-1623
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-0777
  • Fax: 559-437-0795
Mailing address:
  • Phone: 559-437-0777
  • Fax: 559-437-0795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number7582T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: