Provider Demographics
NPI:1285784355
Name:HEALEY, STEPHEN JOE (OD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOE
Last Name:HEALEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14006 RIVERSIDE DR
Mailing Address - Street 2:SPACE 274
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1945
Mailing Address - Country:US
Mailing Address - Phone:818-461-0635
Mailing Address - Fax:
Practice Address - Street 1:363 TOWN CTR E
Practice Address - Street 2:SANTA MARIA TOWN CENTER SPACE G-73
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5159
Practice Address - Country:US
Practice Address - Phone:805-922-6118
Practice Address - Fax:805-922-0139
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP9715Medicare ID - Type Unspecified
CAU36030Medicare UPIN