Provider Demographics
NPI:1376618876
Name:STANG FAMILY EYECARE PC
Entity Type:Organization
Organization Name:STANG FAMILY EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:906-226-8800
Mailing Address - Street 1:622 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3520
Mailing Address - Country:US
Mailing Address - Phone:906-226-8800
Mailing Address - Fax:906-226-8802
Practice Address - Street 1:622 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3520
Practice Address - Country:US
Practice Address - Phone:906-226-8800
Practice Address - Fax:906-226-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP45990001OtherMEDICARE PROVIDER NUMBER
MI900E21080OtherBLUE CROSS AND BLUE SHIELD
MI0P45990OtherMEDICARE GROUP NUMBER
MIP45990001OtherMEDICARE PROVIDER NUMBER
MI944954896Medicaid
MI6018620001Medicare NSC
MI900E21080OtherBLUE CROSS AND BLUE SHIELD