Stevenson, Charles Gordon
Stevenson, Charles Gordon is an sole proprietor health care provider with primary practice located at 770 Hwy 331 South Suite 1, Defuniak Springs FL 32435. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Stevenson, Charles Gordon can be contacted via phone (850) 892-5514.Contact Information
Primary practice address
770 Hwy 331 South Suite 1
Defuniak Springs FL 32435
Phone: (850) 892-5514
Fax: (850) 892-0189
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OP0002311 | Florida |
Profile Details
| NPI number | 1003999756 |
|---|---|
| LBN Legal business name | Stevenson, Charles Gordon |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 23rd, 2006 |
| Last updated | Sep 25th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003999756 | NPPES |
| Florida | MEDICAID | 084170600 |
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