Provider Demographics
NPI:1295303501
Name:PUIG, STEPHANIE NICOLE (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:PUIG
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 1:6711 ORCHID DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2644
Mailing Address - Country:US
Mailing Address - Phone:786-973-6416
Mailing Address - Fax:
Practice Address - Street 1:7800 W 33RD AVE STE 1
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5071
Practice Address - Country:US
Practice Address - Phone:786-515-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist