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

Primary practice address
5301 Highway 153 Hixson TN 37343-4912
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902802176 NPPES
Tennessee Other 3944233 PTAN
Tennessee MEDICAID 1902802176 PTAN

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