Provider Demographics
NPI:1366052110
Name:PALKO, STANLEY ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ROBERT
Last Name:PALKO
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 1:3602 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1111
Mailing Address - Country:US
Mailing Address - Phone:412-606-2536
Mailing Address - Fax:412-767-0437
Practice Address - Street 1:1789 S BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1842
Practice Address - Country:US
Practice Address - Phone:412-241-2020
Practice Address - Fax:412-767-0437
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE5032P152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5032POtherVBA
PA5032POtherVBA