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General NPI Number Information
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NPI Number | 1114118585
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Entity Type | Organization
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Legal Business Name | ANNA FAYE STANLEY OD PC
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 120 SAM WALTON DR VISION CENTER
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-9311
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Country | US
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Telephone | 270-726-8283
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 BROOKHAVEN AVE
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-1020
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Country | US
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Telephone | 270-776-8127
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANNA FAYE STANLEY
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Credential | O.D.
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Telephone | 270-726-8283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1476DT
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License Number State | KY
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