Stan R. Blackwell, A.B.O.C.

Primary specialty

OpticianTaxonomy code 156FX1800X

License

SL2639 Issued in CA

Practice address

10612 Los Alamitos Blvd
Los Alamitos, CA 90720-2116

Phone

(562) 493-3569

Fax

(562) 596-8948

NPI assigned

Apr 26, 2014

Last updated

Apr 26, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mr. Stanley Reed Powell Jr. Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398470400000",
    "number": "1700206901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3178 W LINDACITA LN",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928041725",
            "telephone_number": "714-743-5544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10612 LOS ALAMITOS BLVD",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907202116",
            "telephone_number": "562-493-3569",
            "fax_number": "562-596-8948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "STAN",
        "middle_name": "R.",
        "name_prefix": "Mr.",
        "credential": "A.B.O.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-26",
        "last_updated": "2014-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "CA",
            "license": "SL2639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STANLEY",
            "last_name": "POWELL",
            "middle_name": "REED",
            "prefix": "MR.",
            "suffix": "JR.",
            "credential": "SR.AIRMAN USAF",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Optician in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Optician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.