Provider Demographics
NPI:1427188358
Name:HEADLEE, STEPHEN R (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:HEADLEE
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 1:1226 E DIXIE DR
Mailing Address - Street 2:THE VISION CENTER
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-8856
Mailing Address - Country:US
Mailing Address - Phone:336-626-2458
Mailing Address - Fax:336-626-2433
Practice Address - Street 1:1226 E DIXIE DR
Practice Address - Street 2:THE VISION CENTER
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8856
Practice Address - Country:US
Practice Address - Phone:336-626-2458
Practice Address - Fax:336-626-2433
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC938152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist