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General NPI Number Information
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NPI Number | 1578944450
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Entity Type | Organization
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Legal Business Name | STACEY A WALKER OD PA
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 13250 N 56TH ST STE 102
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-1165
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Country | US
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Telephone | 813-528-8914
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 48764
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City | TAMPA
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State | FL
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Zip | 33646-0124
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Country | US
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Telephone | 954-562-0092
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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. STACEY WALKER
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Credential | O.D.
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Telephone | 813-528-8914
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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 |
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License Number State |
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