Provider Demographics
NPI:1477515856
Name:LAYMAN, STEPHANIE PHILLIPS (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:PHILLIPS
Last Name:LAYMAN
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 1:2043 GREYSTONE SQ
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3576
Mailing Address - Country:US
Mailing Address - Phone:731-668-3424
Mailing Address - Fax:731-668-3425
Practice Address - Street 1:2043 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3576
Practice Address - Country:US
Practice Address - Phone:731-668-3424
Practice Address - Fax:731-668-3425
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT831152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
28639OtherBCBS PIN
410041641OtherRAILROAD MEDICARE
TN3596184Medicaid
28639OtherBCBS PIN
410041641OtherRAILROAD MEDICARE