MEDICARE: SHARON STANICH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4493	OH

General Provider Information

NPI Number	:	1245357003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON STANICH O.D.

Provider Business Mailing Address
First Line	:	660 RED ROCK DR
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-2284
Country	:	US
Telephone Number	:	330-336-3732
Fax Number	:

Provider Business Practice Location Address
First Line	:	796 HOWE AVE
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-5124
Country	:	US
Telephone Number	:	330-922-4393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2007
Last Update Date	:	07/08/2007

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