Provider Demographics
NPI:1790951630
Name:STACEY, FELDA L (DPO)
Entity Type:Individual
Prefix:MS
First Name:FELDA
Middle Name:L
Last Name:STACEY
Suffix:
Gender:F
Credentials:DPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 HILLSBORO CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2707
Mailing Address - Country:US
Mailing Address - Phone:615-297-3524
Mailing Address - Fax:615-297-3525
Practice Address - Street 1:2010 CHURCH ST STE 202
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2001
Practice Address - Country:US
Practice Address - Phone:615-327-4424
Practice Address - Fax:615-327-4964
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN669156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician