Provider Demographics
NPI:1194748509
Name:STEENSMA, DONALD KENNETH (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:KENNETH
Last Name:STEENSMA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 W CHANNEL ISLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2102
Mailing Address - Country:US
Mailing Address - Phone:805-486-3585
Mailing Address - Fax:805-486-3586
Practice Address - Street 1:465 W CHANNEL ISLANDS BLVD
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-2102
Practice Address - Country:US
Practice Address - Phone:805-486-3585
Practice Address - Fax:805-486-3586
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6121TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0061210Medicaid
CASD0061210Medicaid
CAT70088Medicare UPIN
CAOP6121Medicare ID - Type Unspecified