Provider Demographics
NPI:1558052993
Name:NAHHAS, STEPHANIE RITA (OD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RITA
Last Name:NAHHAS
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 1:1243 E BRICKYARD RD APT 344
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-5623
Mailing Address - Country:US
Mailing Address - Phone:847-791-0017
Mailing Address - Fax:
Practice Address - Street 1:755 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2105
Practice Address - Country:US
Practice Address - Phone:801-980-3592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13396953-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist