Provider Demographics
NPI:1528129863
Name:RAMIRO, STACEY L (OD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:L
Last Name:RAMIRO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492-G S. RANDALL RD.
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134
Mailing Address - Country:US
Mailing Address - Phone:630-232-6132
Mailing Address - Fax:630-232-6125
Practice Address - Street 1:1492-G S. RANDALL RD.
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134
Practice Address - Country:US
Practice Address - Phone:630-232-6132
Practice Address - Fax:630-232-6125
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46009611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMK1061895OtherDEA
ILU98849Medicare UPIN