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General NPI Number Information
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NPI Number | 1982654612
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Entity Type | Individual
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Provider Name | HOLLY LYNN STEBEL O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 13075 PERSIMMON LN., SUITE A
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City | BOISE
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State | ID
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Zip | 83713-2078
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Country | US
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Telephone | 208-938-9900
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Fax | 208-939-9264
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Provider Business Mailing Address
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Address Line | 13075 PERSIMMON LN., SUITE A
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City | BOISE
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State | ID
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Zip | 83713
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Country | US
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Telephone | 208-938-9900
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Fax | 208-939-9264
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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 | ODP-1027
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | ODP-1027
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | ODP-1027
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | ODP-1027
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License Number State | ID
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