Healthcare Provider Details

I. General information

NPI: 1790836443
Provider Name (Legal Business Name): STAHL OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E. 5TH AVENUE STE A
SPOKANE WA
99202-1332
US

IV. Provider business mailing address

251 E 5TH AVE SUITE A
SPOKANE WA
99202
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-6501
  • Fax: 509-624-9080
Mailing address:
  • Phone: 509-838-6501
  • Fax: 509-624-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberL0731605
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. DEBORAH L CAMARDA
Title or Position: OWNER
Credential: LDO
Phone: 509-838-6501