Provider Demographics
NPI:1568778702
Name:STUCKE, KACIE LEE (OD)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:LEE
Last Name:STUCKE
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 1:218 READING RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1665
Mailing Address - Country:US
Mailing Address - Phone:614-564-7373
Mailing Address - Fax:
Practice Address - Street 1:218 READING RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1665
Practice Address - Country:US
Practice Address - Phone:513-398-3886
Practice Address - Fax:513-398-9836
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5971152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist