Provider Demographics
NPI:1649601394
Name:STUART, WESLEY D
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:D
Last Name:STUART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 MEADOW GLEN COVE # 112
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1798
Mailing Address - Country:US
Mailing Address - Phone:321-285-6135
Mailing Address - Fax:321-400-1250
Practice Address - Street 1:1900 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5531
Practice Address - Country:US
Practice Address - Phone:407-896-8990
Practice Address - Fax:407-896-6034
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6032156FC0801X, 156FX1800X
GALDO002282156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter