Provider Demographics
NPI:1720077902
Name:HATCH, STANLEY W (OD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:W
Last Name:HATCH
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 1:1200 W GODFREY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3323
Mailing Address - Country:US
Mailing Address - Phone:215-276-6000
Mailing Address - Fax:215-276-1329
Practice Address - Street 1:1200 W GODFREY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3323
Practice Address - Country:US
Practice Address - Phone:215-276-6000
Practice Address - Fax:215-276-1329
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
400637OtherMVP SELECT CARE
OD4600347OtherDEA
VUT0051171OtherTHERAPEUTIC
NYC12261OtherEMPIRE BLUE CROSS
NY01688917Medicaid
NY000471043001OtherBLUE SHIELD OF NORTHEASTE
5117OtherWC
T003144OtherLICENSE
107286OtherBC UTICA
410031286OtherRR MEDICARE
NY53109GMedicare ID - Type Unspecified
NY0693520001Medicare NSC