Basic Information
| Provider Information | |||||||||
| NPI: | 1336340520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES A STEPHENS OD & ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1480 TIMBERLANE RD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323121713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508934005 | ||||||||
| FaxNumber: | 8508939987 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 N JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323442060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509974772 | ||||||||
| FaxNumber: | 8509976453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | STEPHENS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8508934005 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME71349 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 152W00000X | OPC935 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 620174100 | 05 | FL | MEDICAID | 24269 | 01 | FL | BCBS | OTHER |