Individual
STACIE R LYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
9863 BUSLETON AVE, STE A, PHILADELPHIA, PA 19115
(215) 969-1100
Mailing address
1425 SLOAN WAY, AMBLER, PA 19002-1205
(773) 531-5568
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046-009376
IL
152W00000X
Optometrist
Primary
OEG002050
PA
207W00000X
Ophthalmology Physician
046009376
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009376
—
IL
Enumeration date
09/20/2005
Last updated
03/19/2025
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