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General NPI Number Information
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NPI Number | 1871592634
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Entity Type | Organization
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Legal Business Name | STACY G. PASCH, O.D. INC
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 2355 HAYES AVE
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City | FREMONT
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State | OH
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Zip | 43420-2634
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Country | US
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Telephone | 419-333-9638
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Fax | 419-332-0168
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Provider Business Mailing Address
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Address Line | 2355 HAYES AVE
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City | FREMONT
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State | OH
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Zip | 43420-2634
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Country | US
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Telephone | 419-333-9638
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Fax | 419-332-0168
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Authorized Official
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Title or Position | OWNER
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Name | DR. STACY PASCH RELLINGER
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Credential | O.D.
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Telephone | 419-333-9638
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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 | 4960
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License Number State | OH
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