Provider Demographics
NPI:1164402939
Name:STANLEY, ANNA FAYE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:FAYE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:FAYE
Other - Last Name:SKAGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1102 BROOKHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-1020
Mailing Address - Country:US
Mailing Address - Phone:270-726-8283
Mailing Address - Fax:270-726-9842
Practice Address - Street 1:120 SAM WALTON DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-9311
Practice Address - Country:US
Practice Address - Phone:270-726-8283
Practice Address - Fax:270-726-9842
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1476DT152W00000X
IN18002536B152W00000X
NV464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77340438Medicaid
KYP00396722OtherRAILROAD MEDICARE
IN057653Medicare UPIN
KY0995901Medicare PIN
KYP00396722OtherRAILROAD MEDICARE