=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306295894
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRAVIS CHRISTOPHER STEPHENS O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2016
-----------------------------------------------------
Last Update Date | 10/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 608 E BOULEVARD
-----------------------------------------------------
City | KOKOMO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46902-2271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-453-5005
-----------------------------------------------------
Fax | 765-453-8937
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 608 E BOULEVARD
-----------------------------------------------------
City | KOKOMO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46902-2271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-391-8233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 18004064
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT.6497
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------