MEDICARE: DR. TRAVIS CHRISTOPHER 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
1	152W00000X	Optometrist	18004064	IN
2	152W00000X	Optometrist	OPT.6497	OH

General Provider Information

NPI Number	:	1306295894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRAVIS CHRISTOPHER STEPHENS O.D.

Provider Business Mailing Address
First Line	:	608 E BOULEVARD
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-2271
Country	:	US
Telephone Number	:	740-391-8233
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 E BOULEVARD
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-2271
Country	:	US
Telephone Number	:	765-453-5005
Fax Number	:	765-453-8937

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

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	10/14/2025

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