Provider Demographics
NPI:1740369248
Name:HIEB, STACY LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:LYNN
Last Name:HIEB
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 1:8309 W 90TH PL
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4557
Mailing Address - Country:US
Mailing Address - Phone:303-487-4432
Mailing Address - Fax:303-450-0895
Practice Address - Street 1:3867 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-1660
Practice Address - Country:US
Practice Address - Phone:303-450-0200
Practice Address - Fax:303-450-0895
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1746152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08914760Medicaid
COU64327Medicare UPIN
CO08914760Medicaid