Provider Demographics
NPI:1821028507
Name:ERRINGTON, STACIE L (OD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:L
Last Name:ERRINGTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:943 JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230
Mailing Address - Country:US
Mailing Address - Phone:614-476-2015
Mailing Address - Fax:614-428-9856
Practice Address - Street 1:5180 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-866-9002
Practice Address - Fax:614-866-3581
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4556T1299152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11313383OtherCAQH
OHER0767404Medicare PIN
OHER0767402Medicare PIN
11313383OtherCAQH