Provider Demographics
NPI:1386925923
Name:WOLFE, STEPHEN C (OD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:WOLFE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:404 E MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5524
Mailing Address - Country:US
Mailing Address - Phone:210-366-1199
Mailing Address - Fax:210-349-7111
Practice Address - Street 1:15677-B SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-490-9205
Practice Address - Fax:210-490-3633
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7711T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist