Individual
DR. KENNETH L. STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
24 ROSEMONT ST, ALBANY, NY 12203-2405
(518) 438-6669
(518) 489-4372
Mailing address
24 ROSEMONT ST, ALBANY, NY 12203-2405
(518) 438-6669
(518) 489-4372
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV004607-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
931291
—
NY
Enumeration date
06/09/2006
Last updated
10/24/2011
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