Provider Demographics
NPI:1598767337
Name:STIEGEMEIER, MARY JO (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:STIEGEMEIER
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3733 PARK EAST DR STE 104
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4334
Practice Address - Country:US
Practice Address - Phone:216-839-0200
Practice Address - Fax:216-839-0808
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT48084Medicare UPIN
OH0554216Medicare ID - Type Unspecified