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Organization
CHUCK STEVENSON OD PA
Active
Organization
CHUCK STEVENSON OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES G STEVENSON III OD (OWNER)
(850) 892-5514
Entity
Organization
Contact information
Practice address
770 US HIGHWAY 331 S, SUITE 1, DEFUNIAK SPRINGS, FL 32435-3300
(850) 892-5514
(850) 892-0189
Mailing address
PO BOX 1289, DEFUNIAK SPRINGS, FL 32435-1289
(850) 892-5514
(850) 892-0189
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OP0002311
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084170600
—
FL
Enumeration date
11/05/2010
Last updated
11/05/2010
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