Provider Demographics
NPI:1134299209
Name:RELLINGER, STACY PASCH (OD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:PASCH
Last Name:RELLINGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:G
Other - Last Name:PASCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2311 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2634
Mailing Address - Country:US
Mailing Address - Phone:419-334-8121
Mailing Address - Fax:419-332-9351
Practice Address - Street 1:2311 HAYES AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2634
Practice Address - Country:US
Practice Address - Phone:419-334-8121
Practice Address - Fax:419-332-9351
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4960152W00000X
OHOH4960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2321875Medicaid
OH2321875Medicaid
OH4027431Medicare PIN
OH4027431Medicare PIN