Provider Demographics
NPI:1174009724
Name:HUBBARD, STEPHANIE CORYDON (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CORYDON
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PEBBLE BEACH PT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-0124
Mailing Address - Country:US
Mailing Address - Phone:910-850-9220
Mailing Address - Fax:
Practice Address - Street 1:5275 UNIVERSITY PKWY UNIT 123
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-3013
Practice Address - Country:US
Practice Address - Phone:910-850-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC5573OtherFLORIDA OPTOMETRY LICENSE