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General NPI Number Information
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NPI Number | 1437113628
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Entity Type | Individual
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Provider Name | LISA B STEPHAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 9201 BIG HORN BLVD
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City | ELK GROVE
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State | CA
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Zip | 95758-1240
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Country | US
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Telephone | 916-478-5580
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Fax |
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Provider Business Mailing Address
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Address Line | 9023 KERSH CT
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City | ELK GROVE
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State | CA
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Zip | 95624-1272
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Country | US
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Telephone | 916-549-1201
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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 | 12740T
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License Number State | CA
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