Provider Demographics
NPI:1477878155
Name:DR. ANDREA STAMM OD AND ASSOCIATES PSC
Entity type:Organization
Organization Name:DR. ANDREA STAMM OD AND ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-230-9880
Mailing Address - Street 1:524 SHEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7524
Mailing Address - Country:US
Mailing Address - Phone:859-353-4053
Mailing Address - Fax:859-624-9667
Practice Address - Street 1:116 MERIDIAN WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2876
Practice Address - Country:US
Practice Address - Phone:859-353-4053
Practice Address - Fax:859-624-9667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty