Provider Demographics
NPI:1235167412
Name:KEPLEY, STEPHEN R (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:KEPLEY
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 1:1960 25TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3063
Mailing Address - Country:US
Mailing Address - Phone:772-567-5102
Mailing Address - Fax:772-567-5648
Practice Address - Street 1:1960 25TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3063
Practice Address - Country:US
Practice Address - Phone:772-567-5102
Practice Address - Fax:772-567-5648
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1937152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19347Medicare PIN
FLT85244Medicare UPIN
FL0512290001Medicare NSC