Provider Demographics
NPI:1619987575
Name:PRICE-HARRIS, STEPHANIE JO (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JO
Last Name:PRICE-HARRIS
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 1:12417 OCEAN GTWY
Mailing Address - Street 2:SUITE #14
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-9521
Mailing Address - Country:US
Mailing Address - Phone:410-213-9020
Mailing Address - Fax:
Practice Address - Street 1:12417 OCEAN GTWY
Practice Address - Street 2:SUITE #14
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9521
Practice Address - Country:US
Practice Address - Phone:410-213-9020
Practice Address - Fax:410-213-9030
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD136100ZBG3Medicare PIN