Individual
DR. TIMOTHY SHAWN STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
244 GRAND CENTRAL MALL, VIENNA, WV 26101-1105
(304) 485-1199
(304) 428-8102
Mailing address
PO BOX 6018, 244 GRAND CENTRAL MALL, VIENNA, WV 26101-1105
(304) 485-1199
(304) 428-8102
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1004OS
WV
152W00000X
Optometrist
1533DT
KY
152W00000X
Optometrist
2282
TN
152W00000X
Optometrist
5261T2167
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810001212
—
WV
Enumeration date
08/10/2005
Last updated
03/25/2010
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