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NPI Code Detail

MEDICARE: DR. BRIAN STEPHENS O.D.

MEDICARE: DR. BRIAN STEPHENS 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
1152W00000XOptometrist1107AZ

General Provider Information

NPI Number : 1144219825
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN STEPHENS O.D.
Provider Business Mailing Address
First Line : 1316 S MINNEOLA LN
Second Line :
City : GILBERT
State : AZ
Zip : 85296-7824
Country : US
Telephone Number : 480-205-7213
Fax Number : 602-957-0172
Provider Business Practice Location Address
First Line : 4800 N 22ND ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-4701
Country : US
Telephone Number : 602-955-1000
Fax Number : 602-508-4830
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 12/03/2007

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Directions to “ DR. BRIAN STEPHENS O.D.” Practice Location

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