Provider Demographics
NPI:1659386035
Name:PRICE, STEPHANIE JUDKINS (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JUDKINS
Last Name:PRICE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:JUDKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4886 PORT ROYAL RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2975
Mailing Address - Country:US
Mailing Address - Phone:931-489-6118
Mailing Address - Fax:931-451-7416
Practice Address - Street 1:4886 PORT ROYAL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2975
Practice Address - Country:US
Practice Address - Phone:931-489-6118
Practice Address - Fax:931-451-7416
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14122TLG152W00000X
TN2766152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T68957Medicare UPIN