Organization
LOPASTEEDA DEROSA STEPHENS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOPASTEEDA DEROSA STEPHENS (OWNER)
(931) 473-6865
Entity
Organization
Contact information
Practice address
1035 SMITHVILLE HWY, MC MINNVILLE, TN 37110-1691
(931) 473-6865
Mailing address
PO BOX 308, MC MINNVILLE, TN 37111-0308
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
TN1363
TN
Other
Enumeration date
12/07/2007
Last updated
12/07/2007
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