Timothy Shawn Stephens, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1004OS Issued in WV

Practice address

244 Grand Central Mall
Vienna, WV 26101-1105

Phone

(304) 485-1199

Fax

(304) 428-8102

NPI assigned

Aug 10, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Eyedoctors PLLCGroup PAC ID 3274708003, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Eyedoctors PLLC

  • Optometrist
  • Vienna, WV
  • NPI 1538468764
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269475200000",
    "number": "1619979630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6018",
            "address_2": "244 GRAND CENTRAL MALL",
            "city": "VIENNA",
            "state": "WV",
            "postal_code": "261011105",
            "telephone_number": "304-485-1199",
            "fax_number": "304-428-8102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 GRAND CENTRAL MALL",
            "city": "VIENNA",
            "state": "WV",
            "postal_code": "261011105",
            "telephone_number": "304-485-1199",
            "fax_number": "304-428-8102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "TIMOTHY",
        "middle_name": "SHAWN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2010-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "1004OS",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5261T2167",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2282",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1533DT",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810001212",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John A Stavrakis, OD
• Melissa Jane Stavrakis, DPT, OCS
• Stephen R Stanley DO Inc
• Herlinda Stephens
• Lisa Stephens
• Cassandra Stewart
• Emily Stewart
• Kim M Stooke, M.D.
• Cassandra Stoops
• Joy Sturgill

• Optometrist in Vienna, WV
• Providers in Vienna, WV by specialty
• Optometrist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.