Provider Demographics
NPI:1427382530
Name:HELLER, STACY CLARK (OD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:CLARK
Last Name:HELLER
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 1:5335 HIGHWAY 280
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5317
Mailing Address - Country:US
Mailing Address - Phone:205-980-0446
Mailing Address - Fax:205-980-2398
Practice Address - Street 1:5335 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5317
Practice Address - Country:US
Practice Address - Phone:205-980-0446
Practice Address - Fax:205-980-2398
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C23-TA-832152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist