Healthcare Provider Details

I. General information

NPI: 1396835302
Provider Name (Legal Business Name): DR. STEPHEN REED O'CONNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEPHEN REED O'CONNELL MD

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/13/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE BLDG H200
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

40 BLUE ANCHOR CAY RD
CORONADO CA
92118-3201
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-6642
  • Fax: 760-725-0083
Mailing address:
  • Phone: 850-516-3949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC160208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: