Provider Demographics
NPI:1336437854
Name:CESARANO, STACEY MICHELLE (OD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:MICHELLE
Last Name:CESARANO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:51 NORTH 39TH STREET
Mailing Address - Street 2:SCHEIE EYE INSTITUTE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-8100
Mailing Address - Fax:
Practice Address - Street 1:51 NORTH 39TH STREET
Practice Address - Street 2:SCHEIE EYE INSTITUTE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist