Provider Demographics
NPI:1528254661
Name:TREVOR STEIDLEY O.D.
Entity type:Organization
Organization Name:TREVOR STEIDLEY O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-750-1362
Mailing Address - Street 1:100 N D ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3621
Mailing Address - Country:US
Mailing Address - Phone:559-782-0766
Mailing Address - Fax:
Practice Address - Street 1:100 N D ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3621
Practice Address - Country:US
Practice Address - Phone:559-782-0766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10806152W00000X
CA9267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP589AMedicare PIN