Provider Demographics
NPI:1205201936
Name:CORTES, STEPHANIE (OD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CORTES
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 1:706 W BOYNTON BEACH BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3621
Mailing Address - Country:US
Mailing Address - Phone:617-381-7005
Mailing Address - Fax:561-738-9446
Practice Address - Street 1:706 W BOYNTON BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3621
Practice Address - Country:US
Practice Address - Phone:561-738-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5151152W00000X
FLOPC 5151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist