MEDICARE: STEPHEN W HARRELL 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	1293	NC

General Provider Information

NPI Number	:	1609853878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN W HARRELL O.D.

Provider Business Mailing Address
First Line	:	1816 N BRIDGE ST
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-2104
Country	:	US
Telephone Number	:	336-835-2244
Fax Number	:	336-835-9961

Provider Business Practice Location Address
First Line	:	1816 N BRIDGE ST
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-2104
Country	:	US
Telephone Number	:	336-835-2244
Fax Number	:	336-835-9961

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	02/29/2008

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