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NPI Code Detail

MEDICARE: DR. STACY MARIA WASHINGTON OD

MEDICARE: DR. STACY MARIA WASHINGTON OD
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
1152W00000XOptometrist13105CA
2152W00000XOptometrist732NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679592349
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACY MARIA WASHINGTON OD
Provider Business Mailing Address
First Line : 5764 SHADOW BEND DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-1252
Country : US
Telephone Number : 714-600-9982
Fax Number :
Provider Business Practice Location Address
First Line : 2120 E CALVADA BLVD
Second Line :
City : PAHRUMP
State : NV
Zip : 89048-5805
Country : US
Telephone Number : 775-727-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 08/01/2013

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Directions to “ DR. STACY MARIA WASHINGTON OD” Practice Location

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