Provider Demographics
NPI:1619107588
Name:MASTORES, STEPHANIE M (OD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:MASTORES
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 1:6040 N 7TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1848
Mailing Address - Country:US
Mailing Address - Phone:614-915-7174
Mailing Address - Fax:602-855-0825
Practice Address - Street 1:6040 N 7TH STREET SUITE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014
Practice Address - Country:US
Practice Address - Phone:602-825-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1704152W00000X
AZOPT-001704152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist