Provider Demographics
NPI:1609409333
Name:VIVEROS, STEFFANI (OD)
Entity Type:Individual
Prefix:DR
First Name:STEFFANI
Middle Name:
Last Name:VIVEROS
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 1:3111 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2690
Mailing Address - Country:US
Mailing Address - Phone:732-679-2020
Mailing Address - Fax:
Practice Address - Street 1:3111 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2690
Practice Address - Country:US
Practice Address - Phone:732-679-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00695200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist