Chuck Stevenson OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

OP0002311 Issued in FL

Legal business name

CHUCK STEVENSON OD PA

Practice address

770 US Highway 331 S
Suite 1
Defuniak Springs, FL 32435-3300

Phone

(850) 892-5514

Fax

(850) 892-0189

NPI assigned

Nov 5, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Charles G Stevenson III, ODNPI 1003999756

Title

Owner

Phone

(850) 892-5514

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles Gordon Stevenson III, OD

  • Optometrist
  • Defuniak Springs, FL
  • NPI 1003999756

  FL, Optometrist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1288915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288915200000",
    "number": "1962703009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1289",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324351289",
            "telephone_number": "850-892-5514",
            "fax_number": "850-892-0189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 US HIGHWAY 331 S",
            "address_2": "SUITE 1",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324353300",
            "telephone_number": "850-892-5514",
            "fax_number": "850-892-0189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHUCK STEVENSON OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-05",
        "last_updated": "2010-11-05",
        "status": "A",
        "authorized_official_last_name": "STEVENSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-892-5514",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OP0002311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084170600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Defuniak Springs, FL
• Providers in Defuniak Springs, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.