MEDICARE: DR. STEPHANIE GARZA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046.011573	IL

General Provider Information

NPI Number	:	1093472110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE GARZA OD

Provider Business Mailing Address
First Line	:	333 W HUBBARD ST APT 211
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-4743
Country	:	US
Telephone Number	:	219-363-0451
Fax Number	:

Provider Business Practice Location Address
First Line	:	4663 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2540
Country	:	US
Telephone Number	:	708-636-0600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	11/23/2021

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