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General NPI Number Information
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NPI Number | 1538224472
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Entity Type | Individual
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Provider Name | STACEY ANN DE YONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13662A JAMBOREE RD THE MARKET PLACE II
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City | IRVINE
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State | CA
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Zip | 92602-1201
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Country | US
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Telephone | 714-508-4970
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Fax | 714-508-4971
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Provider Business Mailing Address
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Address Line | 28841 GLEN RDG
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City | MISSION VIEJO
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State | CA
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Zip | 92692-4301
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Country | US
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Telephone | 949-680-5420
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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 | 12778
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License Number State | CA
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