Provider Demographics
NPI:1124751417
Name:PLUCINIK, STANLEY ROY (OD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:ROY
Last Name:PLUCINIK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S SIERRA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2227
Mailing Address - Country:US
Mailing Address - Phone:818-451-6765
Mailing Address - Fax:619-422-0114
Practice Address - Street 1:342 F ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2625
Practice Address - Country:US
Practice Address - Phone:619-422-1471
Practice Address - Fax:619-422-0114
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist