Provider Demographics
NPI:1528337540
Name:STEWART, BERNARD VAUGHAN (LDO-LICENSED DISPENS)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:VAUGHAN
Last Name:STEWART
Suffix:
Gender:M
Credentials:LDO-LICENSED DISPENS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BROADWAY - FIRST FLOOR
Mailing Address - Street 2:STEWART OPTICAL SERVICES
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:360-668-5228
Mailing Address - Fax:360-668-4120
Practice Address - Street 1:801 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122
Practice Address - Country:US
Practice Address - Phone:360-668-5228
Practice Address - Fax:360-668-4120
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO00000558156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician