MEDICARE: DR. STEPHEN MARK AVERITT 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	4437T1161	OH

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	:	1194851030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN MARK AVERITT O.D.

Provider Business Mailing Address
First Line	:	3900 MORSE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3016
Country	:	US
Telephone Number	:	614-804-7147
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 MORSE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3016
Country	:	US
Telephone Number	:	614-804-7147
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	11/19/2020

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