Provider Demographics
NPI:1275750986
Name:WEBB, STACEY L (OD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:WEBB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1872 NORWOOD DR
Mailing Address - Street 2:200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3066
Mailing Address - Country:US
Mailing Address - Phone:817-540-6060
Mailing Address - Fax:817-553-7994
Practice Address - Street 1:1872 NORWOOD DR
Practice Address - Street 2:200
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3066
Practice Address - Country:US
Practice Address - Phone:817-540-6060
Practice Address - Fax:817-553-7994
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX05959TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV06240Medicare UPIN