MEDICARE: TODD G STAGNER O.D.

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	152W00000X	Optometrist	4901003590	MI

General Provider Information

NPI Number	:	1568525608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD G STAGNER O.D.

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	:	269-963-1666

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	:	269-963-1666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	02/19/2009

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