Provider Demographics
NPI:1760191696
Name:SILVAGNOLI LUGO, STEPHANIE ANGELY (OD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANGELY
Last Name:SILVAGNOLI LUGO
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 1:4926 SANTIAGO WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-3740
Mailing Address - Country:US
Mailing Address - Phone:787-934-1479
Mailing Address - Fax:
Practice Address - Street 1:4926 SANTIAGO WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-3740
Practice Address - Country:US
Practice Address - Phone:787-934-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003841152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist