Stephens, Timothy Shawn

Stephens, Timothy Shawn is an sole proprietor health care provider with primary practice located at 244 Grand Central Mall , Vienna WV 26101-1105. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Stephens, Timothy Shawn can be contacted via phone (304) 485-1199.

Contact Information

Primary practice address
244 Grand Central Mall Vienna WV 26101-1105
Fax: (304) 428-8102
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1004OS West Virginia
Eye and Vision Services Providers / Optometrist 152W00000X 5261T2167 Ohio
Eye and Vision Services Providers / Optometrist 152W00000X 2282 Tennessee
Eye and Vision Services Providers / Optometrist 152W00000X 1533DT Kentucky

Profile Details

NPI number 1619979630
LBN Legal business name Stephens, Timothy Shawn
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 10th, 2005
Last updated Mar 25th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619979630 NPPES
West Virginia MEDICAID 3810001212

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