Provider Demographics
NPI:1396835302
Name:O'CONNELL, STEPHEN REED
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:REED
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:REED
Other - Last Name:O'CONNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:40 BLUE ANCHOR CAY RD
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3201
Mailing Address - Country:US
Mailing Address - Phone:850-516-3949
Mailing Address - Fax:
Practice Address - Street 1:200 MERCY CIRCLE
Practice Address - Street 2:BLDG H200
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-6642
Practice Address - Fax:760-725-0083
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC160208207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology