Provider Demographics
NPI:1306020540
Name:STAMM FAMILY OPTICAL P.C.
Entity Type:Organization
Organization Name:STAMM FAMILY OPTICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KRISTIN
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-677-2685
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0208
Mailing Address - Country:US
Mailing Address - Phone:814-677-2685
Mailing Address - Fax:814-677-2686
Practice Address - Street 1:3216 STATE ROUTE 257
Practice Address - Street 2:DUAWL PROFESSIONAL PLAZA #7
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-0208
Practice Address - Country:US
Practice Address - Phone:814-677-2685
Practice Address - Fax:814-677-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG1355261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA01355OtherVBA
PAOP2391OtherEYEMED
U84520Medicare UPIN