Healthcare Provider Details

I. General information

NPI: 1740514322
Provider Name (Legal Business Name): STEPHANIE A BRIGGS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 PINE MILL RD
CLARKSBORO NJ
08020-1511
US

IV. Provider business mailing address

247 PINE MILL RD
CLARKSBORO NJ
08020-1511
US

V. Phone/Fax

Practice location:
  • Phone: 856-423-6688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOA5490
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001782
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: