Healthcare Provider Details

I. General information

NPI: 1265491591
Provider Name (Legal Business Name): RAYMOND W STEPP O. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N AUSTIN ST
COMANCHE TX
76442-2408
US

IV. Provider business mailing address

PO BOX 543
COMANCHE TX
76442-0543
US

V. Phone/Fax

Practice location:
  • Phone: 325-356-3266
  • Fax: 325-356-5247
Mailing address:
  • Phone: 325-356-5246
  • Fax: 325-356-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2182TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: