Broecker, Stacey T.
Broecker, Stacey T. is an sole proprietor health care provider with primary practice located at 2356 University Ave W , Saint Paul MN 55114-1897. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Broecker, Stacey T. can be contacted via phone (651) 645-8124.Contact Information
Primary practice address
2356 University Ave W
Saint Paul MN 55114-1897
Phone: (651) 645-8124
Fax: (651) 645-8125
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2108 | Minnesota |
Profile Details
| NPI number | 1922053040 |
|---|---|
| LBN Legal business name | Broecker, Stacey T. |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 24th, 2006 |
| Last updated | Nov 20th, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1922053040 | NPPES |
| Minnesota | MEDICAID | 808023200 |
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