Individual provider Active NPI

Marilou V Stephan, O.D.

  • Optometrist
  • Edina, MN
National Provider Identifier
1558367136
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
MN1770 Issued in MN
Practice address
3333 Hazelton Rd
Edina, MN 55435-4204
Phone
(952) 926-6149
Fax
(952) 926-2729
NPI assigned
Jun 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X MN1770 MN Primary

Addresses

Primary practice location

3333 Hazelton Rd
Edina, MN 55435-4204

Mailing address

3333 Hazelton Rd
Edina, MN 55435-4204
Phone (952) 926-6149

Other identifiers 6

IdentifierTypeStateIssuer
ST794518OtherMNCLARITY VISION
22-20201OtherMNMEDICA/UNITED HEALTH CARE
23750OtherMNAMERICA'S PPO
12083OtherMNCOLE MANAGED VISION CARE
MN 1770OtherMNEYEMED VISION CARE
85601STOtherMNBCBS OF MN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1770MNMDMarriage & Family Therapist
MN1770MNMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Pearle Vision Inc Past Accepting new patients
Visual Edge, Inc Past Accepting new patients
Luxottica of America Inc Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1558367136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 HAZELTON RD",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354204",
            "telephone_number": "952-926-6149",
            "fax_number": "952-926-2729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 HAZELTON RD",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354204",
            "telephone_number": "952-926-6149",
            "fax_number": "952-926-2729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHAN",
        "first_name": "MARILOU",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-28",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "MN1770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLARITY VISION",
            "identifier": "ST794518",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA/UNITED HEALTH CARE",
            "identifier": "22-20201",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO",
            "identifier": "23750",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLE MANAGED VISION CARE",
            "identifier": "12083",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED VISION CARE",
            "identifier": "MN 1770",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF  MN",
            "identifier": "85601ST",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.