Provider Demographics
NPI:1245679471
Name:LOZANO, STEPHANIE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE
Last Name:LOZANO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:MCMILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3405 EDLOE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6520
Mailing Address - Country:US
Mailing Address - Phone:713-797-1500
Mailing Address - Fax:713-797-1150
Practice Address - Street 1:3405 EDLOE ST STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6513
Practice Address - Country:US
Practice Address - Phone:713-797-1500
Practice Address - Fax:713-797-1150
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8187T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00646NOtherMEDICARE GROUP NUMBER