Provider Demographics
NPI:1730273657
Name:STEVENOT, JAMES HERBERT SR (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HERBERT
Last Name:STEVENOT
Suffix:SR
Gender:M
Credentials:OD
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Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2209 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-0902
Practice Address - Country:US
Practice Address - Phone:912-285-2021
Practice Address - Fax:912-285-2558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2025-01-28
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Provider Licenses
StateLicense IDTaxonomies
GAOPT000966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00366484CMedicaid
GA410047413OtherRR MEDICARE
GA52401034003OtherBCBS
GA41ZCCFLMedicare PIN