Provider Demographics
NPI:1063484103
Name:STIMAC, GEORGE RAYMOND (OD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:RAYMOND
Last Name:STIMAC
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 1:35 DEREK LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1739
Mailing Address - Country:US
Mailing Address - Phone:860-683-4490
Mailing Address - Fax:
Practice Address - Street 1:125 BUCKLAND HILLS DR
Practice Address - Street 2:@ TARGET OPTICAL
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8701
Practice Address - Country:US
Practice Address - Phone:860-327-0085
Practice Address - Fax:860-327-0087
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist