Provider Demographics
NPI:1639268873
Name:HASSERT, STACIE LYNNE (OD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:LYNNE
Last Name:HASSERT
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 1:4303 E VISTA BONITA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8774
Mailing Address - Country:US
Mailing Address - Phone:480-369-1730
Mailing Address - Fax:
Practice Address - Street 1:5605 W NORTHERN AVE
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301
Practice Address - Country:US
Practice Address - Phone:623-934-6917
Practice Address - Fax:623-934-6919
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist