Provider Demographics
NPI:1649089897
Name:SWEENEY, STACEY MARIE
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15050 HARRINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-9211
Mailing Address - Country:US
Mailing Address - Phone:440-632-0530
Mailing Address - Fax:440-632-0537
Practice Address - Street 1:15050 HARRINGTON WAY
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9211
Practice Address - Country:US
Practice Address - Phone:440-632-0530
Practice Address - Fax:440-632-0537
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.017807-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician