Individual
MARK STADLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3803 BROADWAY, ASTORIA, NY 11103-4058
(718) 956-3000
(718) 204-0227
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV0040201
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00695345
—
NY
01
—
MS0C329210
BCBS
NY
Enumeration date
02/29/2008
Last updated
08/26/2021
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