Provider Demographics
NPI:1396846267
Name:STANCIK, LAURA (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:STANCIK
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 1:4210 KELL BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-4802
Mailing Address - Country:US
Mailing Address - Phone:940-692-9696
Mailing Address - Fax:940-692-7303
Practice Address - Street 1:4210 KELL BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-4802
Practice Address - Country:US
Practice Address - Phone:940-692-9696
Practice Address - Fax:940-692-7303
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5596T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038272301Medicaid
TX038272301Medicaid
TX81021EMedicare PIN