Provider Demographics
NPI:1447488101
Name:WESTPHAL, STEPHANIE ROBIN (OPTICIAN)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ROBIN
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 VESTAL PARKWAY E.
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2018
Mailing Address - Country:US
Mailing Address - Phone:607-798-1475
Mailing Address - Fax:607-798-9053
Practice Address - Street 1:2405 VESTAL PARKWAY E.
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2018
Practice Address - Country:US
Practice Address - Phone:607-798-1475
Practice Address - Fax:607-798-9053
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6559156FX1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician