Provider Demographics
NPI:1528371721
Name:MENDELL, STEPHANIE D (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:D
Last Name:MENDELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:D
Other - Last Name:CLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1711 N GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-1731
Mailing Address - Country:US
Mailing Address - Phone:405-527-2020
Mailing Address - Fax:405-527-0318
Practice Address - Street 1:1711 N GREEN AVE
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1731
Practice Address - Country:US
Practice Address - Phone:405-527-2020
Practice Address - Fax:405-527-0318
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist