Provider Demographics
NPI:1144248881
Name:STEEN, J. DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:J. DENNIS
Middle Name:
Last Name:STEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 754
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-0754
Mailing Address - Country:US
Mailing Address - Phone:530-257-2020
Mailing Address - Fax:530-257-6566
Practice Address - Street 1:1825 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4518
Practice Address - Country:US
Practice Address - Phone:530-257-2020
Practice Address - Fax:530-257-6566
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44348156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G443480Medicaid
CA00G443480Medicaid
CA00G443480Medicare ID - Type UnspecifiedMEDICARE