Provider Demographics
NPI:1922092105
Name:STOCKING, BEAU STAPF (OD)
Entity Type:Individual
Prefix:DR
First Name:BEAU
Middle Name:STAPF
Last Name:STOCKING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 W MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3039
Mailing Address - Country:US
Mailing Address - Phone:818-841-3840
Mailing Address - Fax:818-841-7739
Practice Address - Street 1:2915 W MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3039
Practice Address - Country:US
Practice Address - Phone:818-841-3840
Practice Address - Fax:818-841-7739
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6119T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist