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General NPI Number Information
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NPI Number | 1326422155
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Entity Type | Organization
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Legal Business Name | STEVENS EYECARE ASSOCIATES PLLC
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 205 4TH AVE
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City | SAINT ALBANS
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State | WV
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Zip | 25177-2821
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Country | US
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Telephone | 304-727-5237
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Fax | 304-727-4051
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Provider Business Mailing Address
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Address Line | 205 4TH AVE
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City | SAINT ALBANS
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State | WV
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Zip | 25177-2821
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Country | US
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Telephone | 304-727-5237
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Fax | 304-727-4051
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. NATHANIEL STEVENS
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Credential | O.D.
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Telephone | 304-727-5237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | WV-1080-OD
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License Number State | WV
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