MEDICARE: DR. STANLEY JOHN HALLOCK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	OPC0001352	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0477150001	OTHER	FL	DMERC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588669238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY JOHN HALLOCK O.D.

Provider Business Mailing Address
First Line	:	5460 CURRY FORD RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-8561
Country	:	US
Telephone Number	:	407-277-1140
Fax Number	:	407-275-0170

Provider Business Practice Location Address
First Line	:	5460 CURRY FORD RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-8561
Country	:	US
Telephone Number	:	407-277-1140
Fax Number	:	407-275-0170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2005
Last Update Date	:	07/08/2007

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