Individual
DR. CHARLES GORDON STEVENSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
770 HWY 331 SOUTH, SUITE 1, DEFUNIAK SPRINGS, FL 32435
(850) 892-5514
(850) 892-0189
Mailing address
PO BOX 1289, DEFUNIAK SPRINGS, FL 32435
(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
10/23/2006
Last updated
09/25/2008
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