Provider Demographics
NPI:1396920450
Name:THE HEALING EDGE VISION
Entity type:Organization
Organization Name:THE HEALING EDGE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:STEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-384-2111
Mailing Address - Street 1:408 LAURKRIS CT
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3573
Mailing Address - Country:US
Mailing Address - Phone:760-384-2111
Mailing Address - Fax:760-384-1901
Practice Address - Street 1:408 LAURKRIS CT
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3573
Practice Address - Country:US
Practice Address - Phone:760-384-2111
Practice Address - Fax:760-384-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG633470208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty