MEDICARE: TODD G STAGNER OD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	900A312400	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1194986869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TODD G STAGNER OD PLLC

Provider Business Mailing Address
First Line	:	228 N HELMER RD
Second Line	:
City	:	SPRINGFIELD
State	:	MI
Zip	:	49037-7931
Country	:	US
Telephone Number	:	269-963-5640
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 N HELMER RD
Second Line	:
City	:	SPRINGFIELD
State	:	MI
Zip	:	49037-7931
Country	:	US
Telephone Number	:	269-963-5640
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. TODD G. STAGNER
Credential	:
Telephone Number	:	269-963-5640

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	02/19/2009

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