Provider Demographics
NPI:1902383540
Name:ASIS, STEPHANIE LE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LE
Last Name:ASIS
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 1:3265 E MIDSUMMER PRIVADO UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-7541
Mailing Address - Country:US
Mailing Address - Phone:951-756-1023
Mailing Address - Fax:
Practice Address - Street 1:47-474 WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253
Practice Address - Country:US
Practice Address - Phone:800-898-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34013TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist