Provider Demographics
NPI:1467673814
Name:EASON, STEPHANIE JOHNSON (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JOHNSON
Last Name:EASON
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 1:96166 DOWLING DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6317
Mailing Address - Country:US
Mailing Address - Phone:904-237-7997
Mailing Address - Fax:904-503-2615
Practice Address - Street 1:464016 STATE ROAD 200
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-6339
Practice Address - Country:US
Practice Address - Phone:904-504-3953
Practice Address - Fax:904-261-8330
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2964152W00000X
FLOPC 2964152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU20707Medicare UPIN