Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG000719 | PA |
NPI | 1013097948 |
---|---|
Provider Name | Dr. Ann Louise Stambach |
First Address | Vienna, VA 22182-3970 |
Second Address | Hanover, PA 17331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 09/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01048985 | (05) | PA |
T30297 | (02) |