Provider Demographics
NPI:1023248838
Name:GONZALES, STEFANIE LYNN (OD)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LYNN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8621
Mailing Address - Country:US
Mailing Address - Phone:972-396-0006
Mailing Address - Fax:972-396-0004
Practice Address - Street 1:1110 N GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8621
Practice Address - Country:US
Practice Address - Phone:972-396-0006
Practice Address - Fax:972-396-0004
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7397T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist