Provider Demographics
NPI:1881244564
Name:DANIEL, STACY MICHELE (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:MICHELE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5781 BRIDGE ST STE 32
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-2944
Mailing Address - Country:US
Mailing Address - Phone:315-314-6681
Mailing Address - Fax:
Practice Address - Street 1:5781 BRIDGE ST STE 32
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2944
Practice Address - Country:US
Practice Address - Phone:315-314-6681
Practice Address - Fax:315-299-4590
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC-005778-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician