Provider Demographics
NPI:1124211776
Name:OPPENHEIMER, STEPHEN (OD, PA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:OPPENHEIMER
Suffix:
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 N ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-7299
Mailing Address - Country:US
Mailing Address - Phone:305-294-5503
Mailing Address - Fax:305-294-5509
Practice Address - Street 1:1708 N ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-7299
Practice Address - Country:US
Practice Address - Phone:305-294-5503
Practice Address - Fax:305-294-5509
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL84289300Medicaid
FL19713ZMedicare PIN