Provider Demographics
NPI:1922050285
Name:STANLEY, JOHN E (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:STANLEY
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 1:69 SAND PIT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4004
Mailing Address - Country:US
Mailing Address - Phone:203-791-2020
Mailing Address - Fax:203-778-6238
Practice Address - Street 1:120 PARK LANE RD STE B203
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2445
Practice Address - Country:US
Practice Address - Phone:203-791-2020
Practice Address - Fax:203-778-6238
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004094637Medicaid