Healthcare Provider Details

I. General information

NPI: 1124545603
Provider Name (Legal Business Name): STEPHANIE CORBIN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W HADDON AVE APT 210
CHICAGO IL
60622-3665
US

IV. Provider business mailing address

2000 W HADDON AVE APT 210
CHICAGO IL
60622-3665
US

V. Phone/Fax

Practice location:
  • Phone: 717-348-3985
  • Fax:
Mailing address:
  • Phone: 717-348-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: