Provider Demographics
NPI:1033295076
Name:STELTZER, DOUGLAS E (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:STELTZER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-0356
Mailing Address - Country:US
Mailing Address - Phone:724-662-5532
Mailing Address - Fax:724-662-0877
Practice Address - Street 1:556 S ERIE ST
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-0356
Practice Address - Country:US
Practice Address - Phone:724-662-5532
Practice Address - Fax:724-662-0877
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000824152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008104300001Medicaid
PA0322510001Medicare NSC
PAT27079Medicare UPIN
PA019888Medicare ID - Type Unspecified