MEDICARE: DAVID R. STACY, O.D., L.L.C.

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	152W00000X	Optometrist	AZ#224	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0249770	OTHER		BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871586628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID R. STACY, O.D., L.L.C.

Provider Business Mailing Address
First Line	:	2974 N. ALMA SCHOOL ROAD
Second Line	:	#3
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6713
Country	:	US
Telephone Number	:	480-899-0188
Fax Number	:	480-899-0199

Provider Business Practice Location Address
First Line	:	2974 N. ALMA SCHOOL ROAD
Second Line	:	#3
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6713
Country	:	US
Telephone Number	:	480-899-0188
Fax Number	:	480-899-0199

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. PATRICIA ANN STACY
Credential	:	B.S.
Telephone Number	:	480-899-0188

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	08/26/2011

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