Individual
STACEY KEPPOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD60840014
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12564332
CAQH PROVIDER NUMBER
PA
05
—
2096921
—
WA
Enumeration date
07/03/2013
Last updated
03/07/2024
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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