Healthcare Provider Details

I. General information

NPI: 1336340520
Provider Name (Legal Business Name): JAMES A STEPHENS OD & ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N JEFFERSON ST
MONTICELLO FL
32344-2060
US

IV. Provider business mailing address

1480 TIMBERLANE RD
TALLAHASSEE FL
32312-1713
US

V. Phone/Fax

Practice location:
  • Phone: 850-997-4772
  • Fax: 850-997-6453
Mailing address:
  • Phone: 850-893-4005
  • Fax: 850-893-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC935
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME71349
License Number StateFL

VIII. Authorized Official

Name: DR. JAMES A STEPHENS
Title or Position: PRESIDENT
Credential: OD
Phone: 850-893-4005