1972645703 NPI number — DR. STACEY J MEIER O.D.

Table of content: DR. STACEY J MEIER O.D. (NPI 1972645703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972645703 NPI number — DR. STACEY J MEIER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEIER
Provider First Name:
STACEY
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972645703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
604 E YEARLING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85085-1817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-434-1229
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3425 W THUNDERBIRD RD STE 17
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85053-5670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-789-1199
Provider Business Practice Location Address Fax Number:
602-886-9505
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AZ0639 . This is a "EYEMED VISION" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: EYEDOX 123 . This is a "EYECARE DIRECT" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 3838 . This is a "AVESIS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 789-1199 . This is a "VISION SERVICE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: MM0627882 . This is a "PERSCRIPTIONS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 119 . This is a "TPA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com