# CHUCK STEVENSON OD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962703009
- **Authorized official:** DR. CHARLES G STEVENSON III OD (OWNER)
- **Authorized official phone:** (850) 892-5514

## Contact information

- **Practice address:** 770 US HIGHWAY 331 S, SUITE 1, DEFUNIAK SPRINGS, FL 32435-3300
- **Practice address phone:** (850) 892-5514
- **Practice address fax:** (850) 892-0189
- **Mailing address:** PO BOX 1289, DEFUNIAK SPRINGS, FL 32435-1289
- **Mailing address phone:** (850) 892-5514
- **Mailing address fax:** (850) 892-0189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OP0002311 | FL | Yes |

## Other

- **Enumeration date:** 11/05/2010
- **Last updated:** 11/05/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 084170600 | — | FL |