Provider Demographics
NPI:1104908755
Name:EVERS, STEVEN RALPH (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RALPH
Last Name:EVERS
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SW 5TH ST
Mailing Address - Street 2:PMB 410
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1352
Mailing Address - Country:US
Mailing Address - Phone:541-325-3450
Mailing Address - Fax:
Practice Address - Street 1:3920 E ASHWOOD RD
Practice Address - Street 2:HEALTH SERVICES-OPTOMETRY
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9703
Practice Address - Country:US
Practice Address - Phone:541-325-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1381ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213199Medicaid
OR213199Medicaid