MEDICARE: SERENA STASKO

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	2446	SC

General Provider Information

NPI Number	:	1366166241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERENA STASKO

Provider Business Mailing Address
First Line	:	PO BOX 880
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-0880
Country	:	US
Telephone Number	:	412-862-9063
Fax Number	:

Provider Business Practice Location Address
First Line	:	9770 DORCHESTER RD UNIT 101
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-7541
Country	:	US
Telephone Number	:	843-767-2328
Fax Number	:

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

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/11/2023

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Directions to “ SERENA STASKO ” Practice Location

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