Provider Demographics
NPI:1639541378
Name:OLNEY, STEVIE KRISTINE (OD)
Entity Type:Individual
Prefix:
First Name:STEVIE
Middle Name:KRISTINE
Last Name:OLNEY
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 1:1668 E 2ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3168
Mailing Address - Country:US
Mailing Address - Phone:951-845-4749
Mailing Address - Fax:
Practice Address - Street 1:1668 E 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3168
Practice Address - Country:US
Practice Address - Phone:951-845-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 15379 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist