Individual
DR. PHILIP BRADLEY STOCKSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
401 E 10TH AVE, SUITE 160, EUGENE, OR 97401-3317
(541) 683-2224
(541) 683-2321
Mailing address
401 E 10TH AVE, SUITE 160, EUGENE, OR 97401-3317
(541) 683-2224
(541) 683-2321
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1408 ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262162
—
OR
Enumeration date
11/01/2006
Last updated
07/08/2007
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