Healthcare Provider Details

I. General information

NPI: 1053414094
Provider Name (Legal Business Name): RICHARD STEPHENSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MAIN ST
JOHNSTOWN PA
15901-1507
US

IV. Provider business mailing address

2661 RIVA RD STE 1030
ANNAPOLIS MD
21401-7131
US

V. Phone/Fax

Practice location:
  • Phone: 814-536-5343
  • Fax: 814-536-1525
Mailing address:
  • Phone: 410-571-8733
  • Fax: 410-571-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOE007964T
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: