Provider Demographics
NPI:1750401501
Name:STACK OPTICAL SERVICES, INC
Entity type:Organization
Organization Name:STACK OPTICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-321-1578
Mailing Address - Street 1:3865 CHERRY CREEK NORTH DR
Mailing Address - Street 2:130
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3803
Mailing Address - Country:US
Mailing Address - Phone:303-321-1578
Mailing Address - Fax:303-322-3431
Practice Address - Street 1:3865 CHERRY CREEK NORTH DR
Practice Address - Street 2:130
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3803
Practice Address - Country:US
Practice Address - Phone:303-321-1578
Practice Address - Fax:303-322-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21075280000332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0928970001Medicare NSC