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General NPI Number Information
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NPI Number | 1730400763
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Entity Type | Organization
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Legal Business Name | DOUGLAS W STEPHEY OD INC
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 208 W BADILLO ST
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City | COVINA
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State | CA
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Zip | 91723-1906
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Country | US
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Telephone | 626-332-4510
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Fax | 626-332-2630
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Provider Business Mailing Address
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Address Line | 208 W BADILLO ST
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City | COVINA
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State | CA
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Zip | 91723-1906
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Country | US
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Telephone | 626-332-4510
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Fax | 626-332-2630
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. DOUG STEPHEY
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Credential | O.D.
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Telephone | 626-332-4510
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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 | OPT8594T
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License Number State | CA
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