Provider Demographics
NPI:1013092121
Name:CAVETT, STANLEY WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:WAYNE
Last Name:CAVETT
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 1:5 STONEBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-6037
Mailing Address - Country:US
Mailing Address - Phone:325-646-8671
Mailing Address - Fax:
Practice Address - Street 1:310 EARLY BLVD
Practice Address - Street 2:
Practice Address - City:EARLY
Practice Address - State:TX
Practice Address - Zip Code:76802-2120
Practice Address - Country:US
Practice Address - Phone:325-646-7996
Practice Address - Fax:325-646-3992
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2594T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124059-03Medicaid
TXUO5468Medicare UPIN
TX83294EMedicare ID - Type Unspecified