Provider Demographics
NPI:1841755212
Name:STUART, JOHN JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:STUART
Suffix:JR
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 1:2709 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-3721
Mailing Address - Country:US
Mailing Address - Phone:214-901-1162
Mailing Address - Fax:
Practice Address - Street 1:12820 HILLCREST RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1516
Practice Address - Country:US
Practice Address - Phone:972-685-2888
Practice Address - Fax:469-340-4231
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-09
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003190152W00000X
NE1616152W00000X
PAOET009161152W00000X
WAOD00001453152W00000X
AZ002667152W00000X
IA116656152W00000X
TX9631TG152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9631TGOtherSTATE LICENSE NUMBER