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General NPI Number Information
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NPI Number | 1689283830
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Entity Type | Individual
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Provider Name | KELSIE STEVENS OD
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Gender | Female
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 6815 N 19TH AVE STE 130
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City | PHOENIX
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State | AZ
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Zip | 85015-1135
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Country | US
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Telephone | 602-242-5293
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Fax |
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Provider Business Mailing Address
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Address Line | 3015 N SCOTTSDALE RD UNIT 4102
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7253
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Country | US
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Telephone | 860-690-0948
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Fax |
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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 | OPT-002450
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License Number State | AZ
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