Individual
DR. THOMAS DALE STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1100 MAIN STREET, FORT MORGAN, CO 80701-4030
(970) 867-3046
(970) 867-3046
Mailing address
1100 MAIN STREET, FORT MORGAN, CO 80701-4030
(970) 867-3046
(970) 867-3046
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
910
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08009102
—
CO
Enumeration date
03/14/2007
Last updated
02/13/2008
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