Provider Demographics
NPI:1518509058
Name:STEPHANIE CORTES OD PA
Entity Type:Organization
Organization Name:STEPHANIE CORTES OD PA
Other - Org Name:CORTES EYE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-512-0979
Mailing Address - Street 1:7806 OAK GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7121
Mailing Address - Country:US
Mailing Address - Phone:954-512-0979
Mailing Address - Fax:
Practice Address - Street 1:706 W BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3649
Practice Address - Country:US
Practice Address - Phone:561-732-5665
Practice Address - Fax:561-738-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty