Provider Demographics
NPI:1295021210
Name:MONTGOMERY, STEPHANIE LEANN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LEANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:LEANN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:21311 S MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-4474
Mailing Address - Country:US
Mailing Address - Phone:423-580-1247
Mailing Address - Fax:
Practice Address - Street 1:118 LOTTIE LN
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2995
Practice Address - Country:US
Practice Address - Phone:251-928-4076
Practice Address - Fax:521-928-9461
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C52-TA-891152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist