Provider Demographics
NPI:1447234711
Name:HUTTO, STACEY S (OD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:S
Last Name:HUTTO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4370
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-4370
Mailing Address - Country:US
Mailing Address - Phone:336-434-4033
Mailing Address - Fax:336-434-6680
Practice Address - Street 1:1577 NEW GARDEN RD STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2798
Practice Address - Country:US
Practice Address - Phone:336-553-0800
Practice Address - Fax:336-553-0353
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist