Individual
DR. STACI DAWN ECENBARGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
5751 BYRON CENTER AVE SW, SUITE V, WYOMING, MI 49519-9621
(616) 532-2020
(616) 532-2022
Mailing address
5751 BYRON CENTER AVE SW, SUITE V, WYOMING, MI 49519-9621
(616) 532-2020
(616) 532-2022
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004004
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5189909
—
MI
Enumeration date
05/30/2006
Last updated
10/30/2007
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