Provider Demographics
NPI:1710947676
Name:POLLACK, STUART BRANDT (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:BRANDT
Last Name:POLLACK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8937 ALTON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4537
Mailing Address - Country:US
Mailing Address - Phone:267-241-9433
Mailing Address - Fax:215-671-1108
Practice Address - Street 1:2536 WELSH RD
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19152-1403
Practice Address - Country:US
Practice Address - Phone:215-671-8000
Practice Address - Fax:215-671-1108
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE004808P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017660790001Medicaid
T29272Medicare UPIN
0497050001Medicare NSC
PA0017660790001Medicaid