Healthcare Provider Details

I. General information

NPI: 1386084119
Provider Name (Legal Business Name): WILLIAM T. K. STEVENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SIERRA ROSE DR
RENO NV
89511-2072
US

IV. Provider business mailing address

610 SIERRA ROSE DR
RENO NV
89511-2072
US

V. Phone/Fax

Practice location:
  • Phone: 775-356-7272
  • Fax: 775-356-2922
Mailing address:
  • Phone: 775-356-7272
  • Fax: 775-356-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number27861
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: