Conrad, Stacy Rebecca
Conrad, Stacy Rebecca is an sole proprietor health care provider with primary practice located at 5301 Highway 153 , Hixson TN 37343-4912. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Conrad, Stacy Rebecca can be contacted via phone (423) 877-9990.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1976 | Tennessee |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1809 | Georgia |
Profile Details
| NPI number | 1902802176 |
|---|---|
| LBN Legal business name | Conrad, Stacy Rebecca |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 22nd, 2005 |
| Last updated | Apr 13th, 2010 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902802176 | NPPES |
| Tennessee | Other | 3944233 | PTAN |
| Tennessee | MEDICAID | 1902802176 | PTAN |
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