Healthcare Provider Details

I. General information

NPI: 1922140078
Provider Name (Legal Business Name): MICHAEL D STEVENSON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E CYPRESS AVE
REDDING CA
96002-0105
US

IV. Provider business mailing address

3480 HILLCREST ST
REDDING CA
96001-3420
US

V. Phone/Fax

Practice location:
  • Phone: 530-722-9992
  • Fax: 530-722-9997
Mailing address:
  • Phone: 530-241-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13176-T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1266
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: