Provider Demographics
NPI:1366442063
Name:STOEGER, ALLY
Entity Type:Individual
Prefix:DR
First Name:ALLY
Middle Name:
Last Name:STOEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ALICJA
Other - Middle Name:
Other - Last Name:STOEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7001 HERITAGE VILLAGE PLZ
Mailing Address - Street 2:110
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3065
Mailing Address - Country:US
Mailing Address - Phone:703-999-9279
Mailing Address - Fax:703-890-2937
Practice Address - Street 1:7001 HERITAGE VILLAGE PLZ
Practice Address - Street 2:110
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3065
Practice Address - Country:US
Practice Address - Phone:703-999-9279
Practice Address - Fax:703-890-2937
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU07539Medicare UPIN