Individual
DALLAS STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1232 PLEASANTVIEW, REXBURG, ID 83440-5316
(208) 709-7314
Mailing address
4255 W SUGARBERRY CT, EAGLE, ID 83616-7266
(208) 709-7314
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100186
ID
Other
Enumeration date
10/21/2008
Last updated
05/01/2020
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