Healthcare Provider Details

I. General information

NPI: 1174658132
Provider Name (Legal Business Name): STACIE ESKEW O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 E BASELINE RD STE 8
GILBERT AZ
85234-2737
US

IV. Provider business mailing address

3921 E BASELINE RD STE 8
GILBERT AZ
85234-2737
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-6560
  • Fax: 480-892-9812
Mailing address:
  • Phone: 480-892-6560
  • Fax: 480-892-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number964
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: