Provider Demographics
NPI:1437582665
Name:PANICCIA, STEFANIA MARIA (OD)
Entity Type:Individual
Prefix:DR
First Name:STEFANIA
Middle Name:MARIA
Last Name:PANICCIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CARR. JOHN WILL HARRIS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-765-1915
Mailing Address - Fax:
Practice Address - Street 1:500 CARRETERA JOHN WILL HARRIS
Practice Address - Street 2:IAUPR SCHOOL OF OPTOMETRY
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-765-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist