Provider Demographics
NPI:1336137553
Name:STAMPER, PATRICIA (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:STAMPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 19
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3241
Mailing Address - Country:US
Mailing Address - Phone:480-961-8999
Mailing Address - Fax:480-961-5009
Practice Address - Street 1:7130 W CHANDLER BLVD
Practice Address - Street 2:SUITE 19
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3241
Practice Address - Country:US
Practice Address - Phone:480-961-8999
Practice Address - Fax:480-961-5009
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ92894OtherPTAN
AZT44373Medicare UPIN
AZ79639Medicare ID - Type UnspecifiedMEDICARE/MEDICAID NUMBER
AZZ92894OtherPTAN