Provider Demographics
NPI:1215283668
Name:STEPHAN, RACHEL L (OD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:L
Other - Last Name:THELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:19389 N 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6500
Mailing Address - Country:US
Mailing Address - Phone:623-537-6000
Mailing Address - Fax:623-537-6014
Practice Address - Street 1:5865 W UTOPIA RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5251
Practice Address - Country:US
Practice Address - Phone:623-537-6000
Practice Address - Fax:623-806-7210
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2913152W00000X
MI4901004947152W00000X
AZ002686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist