Walters, Staci Renee
Walters, Staci Renee is an individual health care provider with primary practice located at 665 S Apollo Blvd , Melbourne FL 32901-1485. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Walters, Staci Renee can be contacted via phone (321) 984-3200.Contact Information
Primary practice address
665 S Apollo Blvd
Melbourne FL 32901-1485
Phone: (321) 984-3200
Fax: (321) 984-0032
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 4395 | Florida |
Profile Details
| NPI number | 1417173832 |
|---|---|
| LBN Legal business name | Walters, Staci Renee |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 17th, 2007 |
| Last updated | Feb 23rd, 2018 - about 6 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 | 1417173832 | NPPES |
| Florida | Other | 053998005 | DEMERC PB |
| Florida | Other | 190CM | DEMERC PB |
| Florida | Other | 053998004 | DEMERC PB |
| Florida | Other | 053998002 | DEMERC PB |
| Florida | Other | 053998003 | DEMERC PB |
| Florida | MEDICAID | 003325900 | DEMERC PB |
| Florida | Other | 0539980006 | DEMERC PB |
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