Healthcare Provider Details

I. General information

NPI: 1033299532
Provider Name (Legal Business Name): T. R. STAHL & ASSOC. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 WOODMAN DR STE 100
DAYTON OH
45420-1159
US

IV. Provider business mailing address

3085 WOODMAN DR STE 100
DAYTON OH
45420-1159
US

V. Phone/Fax

Practice location:
  • Phone: 937-258-1515
  • Fax: 937-258-4128
Mailing address:
  • Phone: 937-258-1515
  • Fax: 937-258-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: LAURA KITCHEL
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 937-258-1515