Provider Demographics
NPI:1609178037
Name:STANLEY J HALLOCK OD PA
Entity Type:Organization
Organization Name:STANLEY J HALLOCK OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-277-1140
Mailing Address - Street 1:5460 CURRY FORD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-8529
Mailing Address - Country:US
Mailing Address - Phone:407-277-1140
Mailing Address - Fax:407-275-0170
Practice Address - Street 1:5460 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-8529
Practice Address - Country:US
Practice Address - Phone:407-277-1140
Practice Address - Fax:407-275-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084905700Medicaid
19086Medicare PIN
T84085Medicare UPIN