Provider Demographics
NPI:1073129664
Name:MUNOZ, STEPHANIE LIANE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LIANE
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1604
Mailing Address - Country:US
Mailing Address - Phone:956-802-9722
Mailing Address - Fax:
Practice Address - Street 1:317 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4801
Practice Address - Country:US
Practice Address - Phone:956-686-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10094T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist