Healthcare Provider Details

I. General information

NPI: 1265424758
Provider Name (Legal Business Name): STEPHANIE A PARIS-WHITNEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 TRAPELO RD SUITE 184
WALTHAM MA
02451-7333
US

IV. Provider business mailing address

1601 TRAPELO RD SUITE 184
WALTHAM MA
02451-7333
US

V. Phone/Fax

Practice location:
  • Phone: 781-890-7797
  • Fax: 781-890-2507
Mailing address:
  • Phone: 781-890-7797
  • Fax: 781-890-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3675
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: