Individual
CYNTHIA LACY-STALLWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
6331 STENTON AVE, PHILADELPHIA, PA 19138-1129
(215) 548-5949
(215) 548-0386
Mailing address
6331 STENTON AVE, PHILADELPHIA, PA 19138-1129
(215) 548-5949
(215) 548-0836
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
06786T
TX
152W00000X
Optometrist
Primary
OET009016
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01560081
—
PA
Enumeration date
07/23/2007
Last updated
05/03/2017
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