Provider Demographics
NPI:1952396707
Name:BESTWINA, STEPHANIE L (OD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:BESTWINA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7095 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6329
Mailing Address - Country:US
Mailing Address - Phone:719-638-4010
Mailing Address - Fax:719-638-4021
Practice Address - Street 1:6310 S US HIGHWAY 85-87
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1006
Practice Address - Country:US
Practice Address - Phone:719-391-2317
Practice Address - Fax:719-390-2947
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3082152W00000X
TN2700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5587945OtherCIGNA
243807OtherUHC
CO35676515Medicaid
TN4204031OtherBCBS
TN3373178Medicaid
TN3373178Medicare PIN
243807OtherUHC
TN3373178Medicaid
TN3373178Medicaid