MEDICARE: RANDI GAIL STEWART OD

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	2059-IOD1	WV
2	152W00000X	Optometrist	TUV008769	NY

General Provider Information

NPI Number	:	1952895450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI GAIL STEWART OD

Provider Business Mailing Address
First Line	:	3840 MCKINLEY PKWY
Second Line	:
City	:	BLASDELL
State	:	NY
Zip	:	14219-3006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 MCKINLEY PKWY
Second Line	:
City	:	BLASDELL
State	:	NY
Zip	:	14219-3006
Country	:	US
Telephone Number	:	726-822-1000
Fax Number	:

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

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	01/03/2023

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