Provider Demographics
NPI:1376209015
Name:HARRIS, STACEY MARIE (OPTICIAN)
Entity Type:Individual
Prefix:MISS
First Name:STACEY
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 16TH ST STE 267
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-4281
Mailing Address - Country:US
Mailing Address - Phone:303-534-0110
Mailing Address - Fax:
Practice Address - Street 1:500 16TH ST STE 267
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-4281
Practice Address - Country:US
Practice Address - Phone:303-534-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician