Provider Demographics
NPI:1053502328
Name:ECKERT, STANLEY MARTIN (OD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:MARTIN
Last Name:ECKERT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6276
Mailing Address - Country:US
Mailing Address - Phone:805-581-5466
Mailing Address - Fax:
Practice Address - Street 1:255 COCHRAN ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6276
Practice Address - Country:US
Practice Address - Phone:805-581-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-02
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist