Provider Demographics
NPI:1952033128
Name:CARRENO, STEPHANIA ALESHK (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIA
Middle Name:ALESHK
Last Name:CARRENO
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 1:1396 CHATLEY WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5527
Mailing Address - Country:US
Mailing Address - Phone:770-871-9994
Mailing Address - Fax:
Practice Address - Street 1:2030 CUMMING HWY STE 106
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8009
Practice Address - Country:US
Practice Address - Phone:678-493-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty