Provider Demographics
NPI:1871592634
Name:STACY G. PASCH, O.D. INC
Entity type:Organization
Organization Name:STACY G. PASCH, O.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:PASCH
Authorized Official - Last Name:RELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-333-9638
Mailing Address - Street 1:2355 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2634
Mailing Address - Country:US
Mailing Address - Phone:419-333-9638
Mailing Address - Fax:419-332-0168
Practice Address - Street 1:2355 HAYES AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2634
Practice Address - Country:US
Practice Address - Phone:419-333-9638
Practice Address - Fax:419-332-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH28482346004OtherMEDICAL MUTUAL OF OHIO
OH9331911OtherMEDICARE GROUP PIN
OH2321875Medicaid
OH000000339206OtherOHIO BLUE CROSS BLUESHIEL
DA9205OtherRAILROAD MEDICARE GRP NUM
P00078028OtherRAILROAD MEDICARE PIN
P00078028OtherRAILROAD MEDICARE PIN
OH9331911OtherMEDICARE GROUP PIN