Provider Demographics
NPI:1831213883
Name:SJAUW, STEPHANIE DEA (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DEA
Last Name:SJAUW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12759 FOOTHILL BLVD SUITE C
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739
Mailing Address - Country:US
Mailing Address - Phone:909-899-0026
Mailing Address - Fax:909-899-6381
Practice Address - Street 1:12759 FOOTHILL BLVD SUITE C
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739
Practice Address - Country:US
Practice Address - Phone:909-899-0026
Practice Address - Fax:909-899-6381
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist