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NPI Code Detail

MEDICARE: STACY J CONWAY OD

MEDICARE: STACY J CONWAY OD
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
1152W00000XOptometristOEG001254PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2P00094885OTHERPAPALMETTO GBA-RRMC
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376543991
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY J CONWAY OD
Provider Business Mailing Address
First Line : 100 N ACADEMY AVE
Second Line :
City : DANVILLE
State : PA
Zip : 17822-9800
Country : US
Telephone Number : 570-808-5441
Fax Number : 570-808-5371
Provider Business Practice Location Address
First Line : 675 BALTIMORE DR
Second Line :
City : WILKES BARRE
State : PA
Zip : 18702-7900
Country : US
Telephone Number : 570-808-5441
Fax Number : 570-808-5371
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 07/29/2020

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Directions to “ STACY J CONWAY OD” Practice Location

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