Individual
DR. STACI DAWN ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2727 FAIRFIELD COMMONS BLVD, BEAVERCREEK, OH 45431-3778
(937) 427-2779
(937) 427-1527
Mailing address
2178 PAINTER PL, MIAMISBURG, OH 45342-3982
(937) 865-9635
(937) 427-1527
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5284
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220039
EYEMED PROVIDER ID #
OH
Enumeration date
02/11/2007
Last updated
07/08/2007
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