Provider Demographics
NPI:1063712941
Name:STEVENS SIGHT SPECIALISTS LLC
Entity type:Organization
Organization Name:STEVENS SIGHT SPECIALISTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:VANCE
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-802-4242
Mailing Address - Street 1:218 WHITEFRIARS LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2520
Mailing Address - Country:US
Mailing Address - Phone:704-575-8827
Mailing Address - Fax:803-802-4246
Practice Address - Street 1:10048 CHARLOTTE HWY (HWY 521)
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-8113
Practice Address - Country:US
Practice Address - Phone:803-802-4242
Practice Address - Fax:803-802-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU472380281Medicare UPIN