Provider Demographics
NPI:1700491156
Name:STEPHENS, RACHEL (OD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:STEPHENS
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 1:8023 COUNTRY CLUB RD N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-3641
Mailing Address - Country:US
Mailing Address - Phone:727-687-7686
Mailing Address - Fax:
Practice Address - Street 1:23902 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1563
Practice Address - Country:US
Practice Address - Phone:727-726-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5849152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist