Individual
DR. STACY REBECCA CONRAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
5301 HIGHWAY 153, HIXSON, TN 37343-4912
(423) 877-9990
Mailing address
8015 MILL CREEK RD, SIGNAL MOUNTAIN, TN 37377-1734
(423) 886-9080
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1809
GA
152W00000X
Optometrist
Primary
1976
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902802176
—
TN
01
—
3944233
PTAN
TN
Enumeration date
06/22/2005
Last updated
04/13/2010
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