Provider Demographics
NPI:1629482690
Name:LOCKE, STACY (OD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:LOCKE
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 1:610 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-1425
Mailing Address - Country:US
Mailing Address - Phone:814-599-3877
Mailing Address - Fax:
Practice Address - Street 1:6535 GRAYSON RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-5141
Practice Address - Country:US
Practice Address - Phone:717-561-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002937152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist