MEDICARE: STEVENS OPTOMETRICS INC

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	046007603	IL

General Provider Information

NPI Number	:	1700157096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVENS OPTOMETRICS INC

Provider Business Mailing 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

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	:	PRESIDENT
Name	:	DR. JAMES M STEVENS
Credential	:	OD
Telephone Number	:	773-836-4110

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	07/19/2012

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