Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OP2897 | FL |
NPI | 1003805169 |
---|---|
Provider Name | Dr. William Henry Stephen |
First Address | Tampa, FL 33625-4007 |
Second Address | Tampa, FL 33625-4007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 24/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U69882 | (02) | FL |