Provider Demographics
NPI:1316931694
Name:RICE, STEPHANIE MICHELLE (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:RICE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7477
Mailing Address - Country:US
Mailing Address - Phone:405-943-2020
Mailing Address - Fax:405-506-3406
Practice Address - Street 1:2800 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7477
Practice Address - Country:US
Practice Address - Phone:405-943-2020
Practice Address - Fax:405-506-3406
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK152WV0400X
OKOK2400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDF6544OtherRAIL ROAD MEDICARE
OK200022840AMedicaid
OKU98713Medicare UPIN
OKDF6544OtherRAIL ROAD MEDICARE
OK243536200Medicare PIN