Healthcare Provider Details

I. General information

NPI: 1386228880
Provider Name (Legal Business Name): STEPHANIE LYNN BARTO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LYNN SLIFKA OD

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 W PALMETTO ST STE AND112
FLORENCE SC
29501-3919
US

IV. Provider business mailing address

1945 W PALMETTO ST UNIT 111
FLORENCE SC
29501-4027
US

V. Phone/Fax

Practice location:
  • Phone: 843-679-1812
  • Fax:
Mailing address:
  • Phone: 843-679-1812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.006941
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.2316
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: