Provider Demographics
NPI:1619301736
Name:GERARD, STEPHANIE ANDREE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANDREE
Last Name:GERARD
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 1:7457 LAS COLINAS BLVD
Mailing Address - Street 2:100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7561
Mailing Address - Country:US
Mailing Address - Phone:214-382-3061
Mailing Address - Fax:
Practice Address - Street 1:7457 LAS COLINAS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7561
Practice Address - Country:US
Practice Address - Phone:214-382-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8224TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist