Provider Demographics
NPI:1922194182
Name:FOZARD, STEPHANIE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:FOZARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:DUNSMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:233 N FRONT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-1669
Mailing Address - Country:US
Mailing Address - Phone:814-342-4611
Mailing Address - Fax:814-342-5840
Practice Address - Street 1:233 N FRONT ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-1669
Practice Address - Country:US
Practice Address - Phone:814-342-4611
Practice Address - Fax:814-342-5840
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00163662OtherMEDICARE RAILROAD
PA0015192290003Medicaid
PAU51535Medicare UPIN
PA533684TJEMedicare PIN