Provider Demographics
NPI:1629184353
Name:SCHAEFER, STEPHANIE CHRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CHRISTINE
Last Name:SCHAEFER
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 1:1451 CORAL RIDGE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2801
Mailing Address - Country:US
Mailing Address - Phone:319-354-5185
Mailing Address - Fax:319-354-4201
Practice Address - Street 1:1451 CORAL RIDGE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2801
Practice Address - Country:US
Practice Address - Phone:319-354-5185
Practice Address - Fax:319-354-4201
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist