Provider Demographics
NPI:1538224472
Name:DE YONG, STACEY ANN (OD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:DE YONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:28841 GLEN RDG
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4301
Mailing Address - Country:US
Mailing Address - Phone:949-680-5420
Mailing Address - Fax:
Practice Address - Street 1:13662A JAMBOREE RD
Practice Address - Street 2:THE MARKET PLACE II
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-1201
Practice Address - Country:US
Practice Address - Phone:714-508-4970
Practice Address - Fax:714-508-4971
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist