Provider Demographics
NPI:1447915913
Name:STEVENSON, TYNYETTA T
Entity type:Individual
Prefix:
First Name:TYNYETTA
Middle Name:T
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-6021
Mailing Address - Country:US
Mailing Address - Phone:856-206-6886
Mailing Address - Fax:
Practice Address - Street 1:102 SUNSET RD
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-6021
Practice Address - Country:US
Practice Address - Phone:856-206-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
No156F00000XEye and Vision Services ProvidersTechnician/Technologist