Organization
KENNETH L. STACK OPTOMETRIST, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH L. STACK OD (PRESIDENT)
(518) 438-6669
Entity
Organization
Contact information
Practice address
24 ROSEMONT ST, ALBANY, NY 12203-2405
(518) 438-6669
(518) 489-4372
Mailing address
24 ROSEMONT ST, ALBANY, NY 12203-2405
(518) 438-6669
(518) 489-4372
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV004607-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00931291
—
NY
Enumeration date
01/24/2008
Last updated
02/25/2008
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