Provider Demographics
NPI:1063542199
Name:STACY G PRESLEY OD PLLC
Entity type:Organization
Organization Name:STACY G PRESLEY OD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-332-5606
Mailing Address - Street 1:1433 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2636
Mailing Address - Country:US
Mailing Address - Phone:580-332-5606
Mailing Address - Fax:580-332-3946
Practice Address - Street 1:1433 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2636
Practice Address - Country:US
Practice Address - Phone:580-332-5606
Practice Address - Fax:580-332-3946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2431332B00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200078050AMedicaid
OKV00594Medicare UPIN
OKOKA101946Medicare PIN
OK200078050AMedicaid
OK6472640001Medicare NSC