=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053349621
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TANIA STEVENS OPTOMETRIST PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5724 E 7TH ST
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90803-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-986-6373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5724 E 7TH ST
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90803-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-986-6373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TANIA STEVENS
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 562-986-6373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 12072
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------