Provider Demographics
NPI:1205863925
Name:PLANCHET, STEPHEN P (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:PLANCHET
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 W OAKLAWN RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-3830
Mailing Address - Country:US
Mailing Address - Phone:830-569-8771
Mailing Address - Fax:830-569-2346
Practice Address - Street 1:1514 W OAKLAWN RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-3830
Practice Address - Country:US
Practice Address - Phone:830-569-8771
Practice Address - Fax:830-569-2346
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05681TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171795101Medicaid
TX8C2570Medicare PIN
TX171795101Medicaid