Provider Demographics
NPI:1316294234
Name:POLATIS, STEVEN M (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:POLATIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2069 E FELDSPAR CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8456
Mailing Address - Country:US
Mailing Address - Phone:208-869-1965
Mailing Address - Fax:208-345-1137
Practice Address - Street 1:1623 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:OWYHEE
Practice Address - State:NV
Practice Address - Zip Code:89832-0103
Practice Address - Country:US
Practice Address - Phone:775-757-2415
Practice Address - Fax:775-757-2066
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0900152WC0802X
OR2940AT152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU5089Medicare UPIN