Healthcare Provider Details

I. General information

NPI: 1225979255
Provider Name (Legal Business Name): SUSAN STANCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 MAHONING AVE
AUSTINTOWN OH
44515-2227
US

IV. Provider business mailing address

6001 MAHONING AVE
AUSTINTOWN OH
44515-2227
US

V. Phone/Fax

Practice location:
  • Phone: 330-270-0013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.017981-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: