Provider Demographics
NPI:1962528620
Name:GRES, STEPHEN (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:GRES
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 1:2547 STATE ROAD 60 E
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-3830
Mailing Address - Country:US
Mailing Address - Phone:813-653-9661
Mailing Address - Fax:
Practice Address - Street 1:2547 STATE ROAD 60 E
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3830
Practice Address - Country:US
Practice Address - Phone:813-653-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist