Provider Demographics
NPI:1073512562
Name:STUTLER, STACY LOUISE (OD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LOUISE
Last Name:STUTLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2232
Mailing Address - Country:US
Mailing Address - Phone:614-898-9989
Mailing Address - Fax:614-898-3054
Practice Address - Street 1:185 S STATE ST
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2232
Practice Address - Country:US
Practice Address - Phone:614-898-9989
Practice Address - Fax:614-898-3054
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2508156Medicaid
OH4141502Medicare PIN
OHST4141501Medicare ID - Type Unspecified
OH2508156Medicaid
OH4141503Medicare PIN