Provider Demographics
NPI:1346351368
Name:STASS-ISERN, MERRILL LEE (MD)
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:LEE
Last Name:STASS-ISERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S WATERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-1626
Mailing Address - Country:US
Mailing Address - Phone:913-244-7100
Mailing Address - Fax:386-447-9568
Practice Address - Street 1:10 S WATERVIEW DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-1626
Practice Address - Country:US
Practice Address - Phone:913-244-7100
Practice Address - Fax:386-447-9568
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8966207W00000X
FLME102930207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200912814Medicaid
MO200912814Medicaid
C51977Medicare UPIN