Provider Demographics
NPI:1295789964
Name:KWAN, STEPHEN D (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:KWAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7103 DEMOCRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1007
Mailing Address - Country:US
Mailing Address - Phone:301-469-4256
Mailing Address - Fax:
Practice Address - Street 1:7103 DEMOCRACY BLVD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1007
Practice Address - Country:US
Practice Address - Phone:301-469-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1837152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist