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General NPI Number Information
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NPI Number | 1104882760
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Entity Type | Individual
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Provider Name | STEPHEN LEE STAHL O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 5806 W CAMELBACK RD
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City | GLENDALE
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State | AZ
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Zip | 85301-7405
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Country | US
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Telephone | 623-937-1655
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Fax |
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Provider Business Mailing Address
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Address Line | 7405 N 84TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85305-3900
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Country | US
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Telephone | 623-877-3352
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 01103
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License Number State | AZ
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