Provider Demographics
NPI:1982654612
Name:STEBEL, HOLLY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:LYNN
Last Name:STEBEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:LYNN
Other - Last Name:ZEMLICKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:13075 PERSIMMON LN., SUITE A
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713
Mailing Address - Country:US
Mailing Address - Phone:208-938-9900
Mailing Address - Fax:208-939-9264
Practice Address - Street 1:13075 PERSIMMON LN., SUITE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2078
Practice Address - Country:US
Practice Address - Phone:208-938-9900
Practice Address - Fax:208-939-9264
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-1027152W00000X, 152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID40858OtherDAVIS
IDV3074OtherBLUECROSS OF IDAHO
ID1902007263OtherGROUP NPI
ID000010160953OtherREGENCE BLUESHIELD OF ID
ID8N117OtherBLUE CROSS OF IDAHO GROUP
IDV3074OtherBLUECROSS OF IDAHO
IDU80628Medicare UPIN
ID4605460001Medicare NSC
ID1370058Medicare PIN