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General NPI Number Information
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NPI Number | 1619979630
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Entity Type | Individual
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Provider Name | TIMOTHY SHAWN STEPHENS OD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 244 GRAND CENTRAL MALL
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City | VIENNA
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State | WV
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Zip | 26101-1105
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Country | US
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Telephone | 304-485-1199
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Fax | 304-428-8102
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Provider Business Mailing Address
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Address Line | PO BOX 6018 244 GRAND CENTRAL MALL
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City | VIENNA
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State | WV
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Zip | 26101-1105
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Country | US
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Telephone | 304-485-1199
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Fax | 304-428-8102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1004OS
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5261T2167
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2282
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1533DT
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License Number State | KY
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