MEDICARE: DR. STEVEN PREVISICH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	10404T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093889982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN PREVISICH O.D.

Provider Business Mailing Address
First Line	:	2137 E LINCOLN AVE
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-4106
Country	:	US
Telephone Number	:	714-772-1300
Fax Number	:	714-999-1439

Provider Business Practice Location Address
First Line	:	2174 E LINCOLN AVE
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-4104
Country	:	US
Telephone Number	:	714-772-1300
Fax Number	:	714-999-1439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	03/06/2024

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