Provider Demographics
NPI:1184631343
Name:APPLEBAUM, STEPHEN ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALAN
Last Name:APPLEBAUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:692 MOONDALE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4236
Mailing Address - Country:US
Mailing Address - Phone:915-833-3234
Mailing Address - Fax:915-833-2285
Practice Address - Street 1:865 N RESLER DR
Practice Address - Street 2:STE. F
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1784
Practice Address - Country:US
Practice Address - Phone:915-833-0633
Practice Address - Fax:915-833-2285
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4769T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410003250730Medicaid