Provider Demographics
NPI:1427806637
Name:YOUREN, STEPHANIE (OD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:YOUREN
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 1:5315 ELMORE RD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-3704
Mailing Address - Country:US
Mailing Address - Phone:208-740-4997
Mailing Address - Fax:
Practice Address - Street 1:350 EAST LN S
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-3058
Practice Address - Country:US
Practice Address - Phone:541-889-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-11
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORATI4719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program