MEDICARE: DR. ANDREA STAMM OD AND ASSOCIATES PSC

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

General Provider Information

NPI Number	:	1477878155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ANDREA STAMM OD AND ASSOCIATES PSC

Provider Business Mailing Address
First Line	:	524 SHEARWATER DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-7524
Country	:	US
Telephone Number	:	859-353-4053
Fax Number	:	859-624-9667

Provider Business Practice Location Address
First Line	:	116 MERIDIAN WAY
Second Line	:	SUITE 3
City	:	RICHMOND
State	:	KY
Zip	:	40475-2876
Country	:	US
Telephone Number	:	859-353-4053
Fax Number	:	859-624-9667

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREA STAMM
Credential	:	OD
Telephone Number	:	859-230-9880

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/06/2010

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