Provider Demographics
NPI:1033298013
Name:ELBRAND, STANLEY J (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:J
Last Name:ELBRAND
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 NORTHEAST 163 STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4623
Mailing Address - Country:US
Mailing Address - Phone:305-945-3361
Mailing Address - Fax:305-945-3361
Practice Address - Street 1:1372 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4623
Practice Address - Country:US
Practice Address - Phone:305-945-3361
Practice Address - Fax:305-945-3361
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL751156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0867021000Medicaid
FL0867021000Medicaid