Provider Demographics
NPI:1992986905
Name:MORRIS, STEVEN D (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:MORRIS
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 1:621 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3519
Mailing Address - Country:US
Mailing Address - Phone:906-225-1373
Mailing Address - Fax:906-225-1374
Practice Address - Street 1:621 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3519
Practice Address - Country:US
Practice Address - Phone:906-225-1373
Practice Address - Fax:906-225-1374
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002822152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE26510OtherBCBSM
MIT79420Medicare UPIN
MIOE26510Medicare PIN