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General NPI Number Information
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NPI Number | 1508154881
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Entity Type | Individual
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Provider Name | STACEY LANA BAUGAARD O.D
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Gender | Female
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 100 W BIG BEAVER RD SUITE 655
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City | TROY
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State | MI
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Zip | 48084-5206
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Country | US
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Telephone | 419-874-0393
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 HAMILTON ST PH 107
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City | PHILADELPHIA
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State | PA
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Zip | 19130-4201
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Country | US
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Telephone | 267-615-1502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OEG002515
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License Number State | PA
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