Provider Demographics
NPI:1639658081
Name:STEFANICK, JEFF STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:STEPHEN
Last Name:STEFANICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 BERKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1219
Mailing Address - Country:US
Mailing Address - Phone:610-374-3134
Mailing Address - Fax:610-374-3668
Practice Address - Street 1:50 BERKSHIRE CT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1219
Practice Address - Country:US
Practice Address - Phone:610-374-3134
Practice Address - Fax:610-374-3668
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist