Healthcare Provider Details

I. General information

NPI: 1336838630
Provider Name (Legal Business Name): STEFANIE RAE FERNANDEZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 BLUE RIDGE RD
RALEIGH NC
27607-0113
US

IV. Provider business mailing address

2921 BRITMASS DR
RALEIGH NC
27616-8445
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-5400
  • Fax:
Mailing address:
  • Phone: 401-741-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2747
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: