=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932278256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATHAN C. STEBBINS, O.D.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 S FINDLEY ST
-----------------------------------------------------
City | PUNXSUTAWNEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15767-2048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-938-5920
-----------------------------------------------------
Fax | 814-938-6926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 S FINDLEY ST
-----------------------------------------------------
City | PUNXSUTAWNEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15767-2048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-938-5920
-----------------------------------------------------
Fax | 814-938-6926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NATHAN STEBBINS
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 814-938-5920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG01190
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------