Provider Demographics
NPI:1952346645
Name:DANNY KEITH STAMPS
Entity type:Organization
Organization Name:DANNY KEITH STAMPS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:STAMPS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-323-3698
Mailing Address - Street 1:1669 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3425
Mailing Address - Country:US
Mailing Address - Phone:910-323-3698
Mailing Address - Fax:910-323-3491
Practice Address - Street 1:1669 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3425
Practice Address - Country:US
Practice Address - Phone:910-323-3698
Practice Address - Fax:910-323-3491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1060152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09292OtherBLUECROSSBLUE SHIELD
NC8909871Medicaid
NC8909292Medicaid
NC8909292Medicaid
NC246607CMedicare PIN