Provider Demographics
NPI:1689302101
Name:PRICE, STEPHANIE DUNCAN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DUNCAN
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8104
Mailing Address - Country:US
Mailing Address - Phone:502-633-5685
Mailing Address - Fax:502-633-9539
Practice Address - Street 1:500 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8104
Practice Address - Country:US
Practice Address - Phone:502-633-5685
Practice Address - Fax:502-633-9539
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician