Healthcare Provider Details

I. General information

NPI: 1326422155
Provider Name (Legal Business Name): STEVENS EYECARE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 4TH AVE
SAINT ALBANS WV
25177-2821
US

IV. Provider business mailing address

205 4TH AVE
SAINT ALBANS WV
25177-2821
US

V. Phone/Fax

Practice location:
  • Phone: 304-727-5237
  • Fax: 304-727-4051
Mailing address:
  • Phone: 304-727-5237
  • Fax: 304-727-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberWV-1080-OD
License Number StateWV

VIII. Authorized Official

Name: DR. NATHANIEL STEVENS
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 304-727-5237