Provider Demographics
NPI:1174607550
Name:STEVENS, RHONDA JOAN (OD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:JOAN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1217 S GREELEY HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-3034
Mailing Address - Country:US
Mailing Address - Phone:307-634-3452
Mailing Address - Fax:307-634-6643
Practice Address - Street 1:1217 S GREELEY HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3034
Practice Address - Country:US
Practice Address - Phone:307-634-3452
Practice Address - Fax:307-634-6643
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY212T152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY310990OtherBLUE CROSS BLUE SHIELD
WY310990Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER
WYU48904Medicare UPIN