Provider Demographics
NPI:1992255038
Name:STUCKEY, JOHN E (LDO)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:STUCKEY
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S MIAMI ST
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-1551
Mailing Address - Country:US
Mailing Address - Phone:937-698-4456
Mailing Address - Fax:
Practice Address - Street 1:104 S MIAMI ST
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-1551
Practice Address - Country:US
Practice Address - Phone:937-698-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-6884156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician