Provider Demographics
NPI:1720198567
Name:STEFANIK, TEAL ANN SHERWIN (OD)
Entity Type:Individual
Prefix:DR
First Name:TEAL
Middle Name:ANN SHERWIN
Last Name:STEFANIK
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 1:5696 ERIK LN
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-4842
Mailing Address - Country:US
Mailing Address - Phone:651-552-7031
Mailing Address - Fax:
Practice Address - Street 1:18185 ZANE ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-4505
Practice Address - Country:US
Practice Address - Phone:763-441-5428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist