Provider Demographics
NPI:1316942352
Name:BELANGER, STEPHEN R (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:BELANGER
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 1:4240 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4238
Mailing Address - Country:US
Mailing Address - Phone:419-475-6605
Mailing Address - Fax:419-475-2017
Practice Address - Street 1:4240 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4238
Practice Address - Country:US
Practice Address - Phone:419-475-6605
Practice Address - Fax:419-475-2017
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3590152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0504387Medicaid
3943320001Medicare NSC