Provider Demographics
NPI:1265618300
Name:STACY VO OD INC
Entity type:Organization
Organization Name:STACY VO OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:KT
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-748-0400
Mailing Address - Street 1:1550 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5456
Mailing Address - Country:US
Mailing Address - Phone:909-748-0400
Mailing Address - Fax:909-748-0446
Practice Address - Street 1:1550 BARTON RD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5456
Practice Address - Country:US
Practice Address - Phone:909-748-0400
Practice Address - Fax:909-748-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-19
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12492T302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07139ZMedicare PIN