Provider Demographics
NPI:1629380779
Name:COLORADO, STEPHANIE MARIE (OD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:COLORADO
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 1:3808 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:#100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8973
Mailing Address - Country:US
Mailing Address - Phone:512-328-0555
Mailing Address - Fax:512-340-0009
Practice Address - Street 1:3808 SPICEWOOD SPRINGS RD
Practice Address - Street 2:#100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8973
Practice Address - Country:US
Practice Address - Phone:512-328-0555
Practice Address - Fax:512-340-0009
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7550T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist