=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447375795
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE LYNN WOLMAN O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 MAMARONECK AVE SUITE 410
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10528-1634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-777-5767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 188 OLD MAMARONECK RD
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10605-3212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-261-0341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WV0400X
-----------------------------------------------------
Taxonomy Name | Vision Therapy Optometrist
-----------------------------------------------------
License Number | 006082
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------