Provider Demographics
NPI:1932148012
Name:MCDONALD, STEPHANIE M (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:MCDONALD
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 1:7 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-2166
Mailing Address - Country:US
Mailing Address - Phone:740-335-1181
Mailing Address - Fax:740-335-1182
Practice Address - Street 1:7 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-2166
Practice Address - Country:US
Practice Address - Phone:740-335-1181
Practice Address - Fax:740-335-1182
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000390796OtherBC BS
OH2201384OtherUHC
OHMEDICAL MUTUALOther204403890001
OHU78368Medicare UPIN
OHMEDICAL MUTUALOther204403890001
OH5676240001Medicare NSC