Healthcare Provider Details

I. General information

NPI: 1417352238
Provider Name (Legal Business Name): STEPHANIE N. KAI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E. BANDERA ROAD SUITE 403
BOERNE TX
78006-2849
US

IV. Provider business mailing address

124 E. BANDERA ROAD SUITE 403
BOERNE TX
78006-2849
US

V. Phone/Fax

Practice location:
  • Phone: 830-331-8745
  • Fax: 830-331-8749
Mailing address:
  • Phone: 830-331-8745
  • Fax: 830-331-8749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT15032TLG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8775TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: