Individual
MR. STAN R. BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
A.B.O.C.
Contact information
Practice address
10612 LOS ALAMITOS BLVD, LOS ALAMITOS, CA 90720-2116
(562) 493-3569
(562) 596-8948
Mailing address
3178 W LINDACITA LN, ANAHEIM, CA 92804-1725
(714) 743-5544
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
SL2639
CA
Other
Enumeration date
04/26/2014
Last updated
04/26/2014
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