Healthcare Provider Details

I. General information

NPI: 1164469490
Provider Name (Legal Business Name): STEPHANIE ELAINE YEE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N ORLANDO AVE SUITE 139
WINTER PARK FL
32789-7313
US

IV. Provider business mailing address

501 N ORLANDO AVE SUITE 139
WINTER PARK FL
32789-7313
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-2211
  • Fax: 407-644-1686
Mailing address:
  • Phone: 407-644-2211
  • Fax: 407-644-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 3409
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000810
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: