Provider Demographics
NPI:1821306119
Name:AMANDA STEBBINS, OD, PA
Entity Type:Organization
Organization Name:AMANDA STEBBINS, OD, PA
Other - Org Name:THE SPECTACLE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-409-8123
Mailing Address - Street 1:7335 W SAND LAKE RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5538
Mailing Address - Country:US
Mailing Address - Phone:407-409-8123
Mailing Address - Fax:407-409-8124
Practice Address - Street 1:7335 W SAND LAKE RD
Practice Address - Street 2:SUITE 119
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5538
Practice Address - Country:US
Practice Address - Phone:407-409-8123
Practice Address - Fax:407-409-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC004107152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDQ309AMedicare PIN