Provider Demographics
NPI:1730167354
Name:HAMLET, STACY JO (OD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:JO
Last Name:HAMLET
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 1:794 TUOLUMNE AVE
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4252
Mailing Address - Country:US
Mailing Address - Phone:805-777-1073
Mailing Address - Fax:
Practice Address - Street 1:140 W HILLCREST DR
Practice Address - Street 2:112
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4221
Practice Address - Country:US
Practice Address - Phone:805-497-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11645T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88161Medicare UPIN
CAWOP11645CMedicare PIN