Provider Demographics
NPI:1881683589
Name:STOCKER, ERIC G (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:STOCKER
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 1:182 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2230
Mailing Address - Country:US
Mailing Address - Phone:440-988-4419
Mailing Address - Fax:440-988-8020
Practice Address - Street 1:182 PARK AVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2230
Practice Address - Country:US
Practice Address - Phone:440-988-4419
Practice Address - Fax:440-988-8020
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3638T672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000127104OtherANTHEM BC/BS
410023295OtherRAILROAD MEDICARE
OH341096031029OtherCARESOURCE
0242340001OtherADMINISTAR FEDERAL
OH3638OtherEYEMED
OH3638OtherEYEMED
0242340001OtherADMINISTAR FEDERAL