Provider Demographics
NPI:1528027869
Name:BOREY, STEPHANIE T (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:T
Last Name:BOREY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:T
Other - Last Name:BOREY-WARMUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:258 ROUTE 12
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3415
Mailing Address - Country:US
Mailing Address - Phone:860-445-2200
Mailing Address - Fax:860-445-2233
Practice Address - Street 1:258 ROUTE 12
Practice Address - Street 2:SUITE 3
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3415
Practice Address - Country:US
Practice Address - Phone:860-445-2200
Practice Address - Fax:860-445-2233
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU75072Medicare UPIN