Provider Demographics
NPI:1275635179
Name:STELLA, SAMUEL VICTOR (OD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:VICTOR
Last Name:STELLA
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 1:15057 GOLDENWEST ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2710
Mailing Address - Country:US
Mailing Address - Phone:714-894-5556
Mailing Address - Fax:714-895-3126
Practice Address - Street 1:15057 GOLDENWEST ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2710
Practice Address - Country:US
Practice Address - Phone:714-894-5556
Practice Address - Fax:714-895-3126
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5214T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0052140OtherBLUE SHIELD
CAWOP5214AMedicare PIN
CAT69995Medicare UPIN
CA0909260001Medicare NSC