Provider Demographics
NPI:1932375367
Name:SCHORNER, STACY M (OD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:SCHORNER
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 207261
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7261
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:630 COMFORT LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-6199
Practice Address - Country:US
Practice Address - Phone:704-289-5455
Practice Address - Fax:704-291-2207
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2099152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093X9OtherBCBS
NC2941385OtherUNITED HEALTHCARE
NC5909701Medicaid
NC2941385OtherUNITED HEALTHCARE
NC2473182Medicare PIN
NC093X9OtherBCBS
NC2473182BMedicare PIN