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NPI Code Detail

MEDICARE: DR. AMY M STEPHENS O.D.

MEDICARE: DR. AMY M 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
1152W00000XOptometristOPC3179FL
2152W00000XOptometrist001621GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3410037564OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
220842OTHERFLBLUR CROSS BLUE SHIELD
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598825184
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY M STEPHENS O.D.
Provider Business Mailing Address
First Line : 1950 OLD GALLOWS RD
Second Line : STE 520
City : VIENNA
State : VA
Zip : 22182-3970
Country : US
Telephone Number : 850-893-4005
Fax Number : 850-894-5462
Provider Business Practice Location Address
First Line : 15196 US HIGHWAY 19 S
Second Line :
City : THOMASVILLE
State : GA
Zip : 31757-4820
Country : US
Telephone Number : 229-228-4770
Fax Number : 229-225-9060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2006
Last Update Date : 02/16/2018

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