Provider Demographics
NPI:1801088976
Name:WALKER, STACEY ANN (OD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ANN
Last Name:WALKER
Suffix:
Gender:F
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:PO BOX 48764
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0124
Mailing Address - Country:US
Mailing Address - Phone:954-562-0092
Mailing Address - Fax:
Practice Address - Street 1:13250 N 56TH ST STE 102
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1165
Practice Address - Country:US
Practice Address - Phone:813-528-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist