Provider Demographics
NPI:1285786095
Name:CARNATION OPTICAL INC.
Entity type:Organization
Organization Name:CARNATION OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:330-821-5476
Mailing Address - Street 1:75 GLAMORGAN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2938
Mailing Address - Country:US
Mailing Address - Phone:330-821-5476
Mailing Address - Fax:330-821-1545
Practice Address - Street 1:75 GLAMORGAN ST STE 111
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2938
Practice Address - Country:US
Practice Address - Phone:330-821-5476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3920152W00000X
OH6204156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1199630001Medicare ID - Type Unspecified