Basic Information
| Provider Information | |||||||||
| NPI: | 1952304685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 518 WEST AVE | ||||||||
| Address2: | |||||||||
| City: | TALLMADGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442782117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306309699 | ||||||||
| FaxNumber: | 3306302173 | ||||||||
| Practice Location | |||||||||
| Address1: | 518 WEST AVE | ||||||||
| Address2: | |||||||||
| City: | TALLMADGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442782117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306309699 | ||||||||
| FaxNumber: | 3306302173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2005 | ||||||||
| LastUpdateDate: | 03/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 3628 | OH | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | 3628 | OH | Y |
ID Information
| ID | Type | State | Issuer | Description | P00191478 | 01 | OH | RAILROAD MEDICARE | OTHER | 2348372 | 05 | OH | MEDICAID | 000000171260 | 01 | UNISON | OTHER | 340976110DS | 01 | OH | SUMMA | OTHER | 730481 | 01 | OH | BUCKEYE | OTHER | 000000354882 | 01 | OH | ANTHEM | OTHER | 204862812 | 01 | OH | UNITED HEALTHCARE | OTHER | 341572960031 | 01 | CARESOURCE | OTHER | 7949318 | 01 | OH | AETNA PPO | OTHER |