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General NPI Number Information
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NPI Number | 1598767337
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Entity Type | Individual
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Provider Name | MARY JO STIEGEMEIER O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 1103 JOHN SIMS PKWY E
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City | NICEVILLE
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State | FL
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Zip | 32578-2752
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Country | US
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Telephone | 850-279-4361
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Fax | 850-279-4363
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Provider Business Mailing Address
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Address Line | 5582 E BAY BLVD
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City | GULF BREEZE
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State | FL
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Zip | 32563-9406
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Country | US
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Telephone |
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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 | 3694
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC6642
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License Number State | FL
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