MEDICARE: JAMES M STEVENS 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	046-007603	IL

General Provider Information

NPI Number	:	1508920349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES M STEVENS O.D.

Provider Business Mailing Address
First Line	:	2407 NEWPORT DR
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-3166
Country	:	US
Telephone Number	:	815-439-3064
Fax Number	:	815-439-3882

Provider Business Practice Location Address
First Line	:	1601 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-4303
Country	:	US
Telephone Number	:	773-836-4110
Fax Number	:	773-637-1109

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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