Individual
DR. HOLLY LYNN STEBEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
13075 PERSIMMON LN., SUITE A, BOISE, ID 83713-2078
(208) 938-9900
(208) 939-9264
Mailing address
13075 PERSIMMON LN., SUITE A, BOISE, ID 83713
(208) 938-9900
(208) 939-9264
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-1027
ID
152WC0802X
Corneal and Contact Management Optometrist
ODP-1027
ID
152WP0200X
Pediatric Optometrist
ODP-1027
ID
152WS0006X
Sports Vision Optometrist
ODP-1027
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010160953
REGENCE BLUESHIELD OF ID
ID
01
—
1902007263
GROUP NPI
ID
01
—
40858
DAVIS
ID
01
—
8N117
BLUE CROSS OF IDAHO GROUP
ID
01
—
V3074
BLUECROSS OF IDAHO
ID
Enumeration date
05/11/2006
Last updated
02/18/2008
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