MEDICARE: LOPASTEEDA DEROSA STEPHENS 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	OD0000001363	TN
2	152W00000X	Optometrist	36116	CA
3	152W00000X	Optometrist	OPT.007417	OH
4	152W00000X	Optometrist	030.0134031TELE	VT
5	152W00000X	Optometrist	905-IOD	WV
6	152W00000X	Optometrist	OPT-2025-0020	NM
7	152W00000X	Optometrist	4108-35	WI
8	152W00000X	Optometrist	OPT.0004135	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972507317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOPASTEEDA DEROSA STEPHENS OD

Provider Business Mailing Address
First Line	:	PO BOX 308
Second Line	:
City	:	MC MINNVILLE
State	:	TN
Zip	:	37111-0308
Country	:	US
Telephone Number	:	931-473-6865
Fax Number	:	931-473-5870

Provider Business Practice Location Address
First Line	:	915 N CHANCERY ST
Second Line	:	STE 120
City	:	MCMINNVILLE
State	:	TN
Zip	:	37110-1575
Country	:	US
Telephone Number	:	931-473-6865
Fax Number	:	931-473-5269

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	12/16/2025

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Directions to “ LOPASTEEDA DEROSA STEPHENS OD” Practice Location

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