Individual
STACY J CONWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
675 BALTIMORE DR, WILKES BARRE, PA 18702-7900
(570) 808-5441
(570) 808-5371
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-9800
(570) 808-5441
(570) 808-5371
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001254
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019617250001
—
PA
05
—
0019617250002
—
PA
01
—
P00094885
PALMETTO GBA-RRMC
PA
Enumeration date
07/26/2005
Last updated
07/29/2020
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