Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2678ATI | OR |
NPI | 1003938457 |
---|---|
Provider Name | Dr. Stacy L Metzger |
First Address | Woodburn, OR 97071-2904 |
Second Address | Woodburn, OR 97071-2904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2007 |
Last Update Date | 01/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U74735 | (02) | OR |