Provider Demographics
NPI:1306801972
Name:GRIFFIN, STEPHANNIE (OD)
Entity type:Individual
Prefix:MRS
First Name:STEPHANNIE
Middle Name:
Last Name:GRIFFIN
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 1:10224 DURANT RD
Mailing Address - Street 2:STE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614
Mailing Address - Country:US
Mailing Address - Phone:919-870-6116
Mailing Address - Fax:919-870-9892
Practice Address - Street 1:10224 DURANT RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614
Practice Address - Country:US
Practice Address - Phone:919-870-6116
Practice Address - Fax:919-870-9892
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2472168AMedicare PIN
U92160Medicare UPIN