Active NPI
Marilou V Stephan, O.D.
- Optometrist
- Edina, MN
National Provider Identifier
1558367136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- MN1770
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ST794518 | Other | MN | CLARITY VISION |
| 22-20201 | Other | MN | MEDICA/UNITED HEALTH CARE |
| 23750 | Other | MN | AMERICA'S PPO |
| 12083 | Other | MN | COLE MANAGED VISION CARE |
| MN 1770 | Other | MN | EYEMED VISION CARE |
| 85601ST | Other | MN | BCBS 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
| License | State | Type | Specialty |
|---|---|---|---|
| 1770 | MN | MD | Marriage & Family Therapist |
| MN1770 | MN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New 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.
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- Eyewear Supplier
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- NPI 1982744033
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.