Healthcare Provider Details

I. General information

NPI: 1992868269
Provider Name (Legal Business Name): GREGORY A STAINER MD FACS A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CHINA GRADE LOOP
BAKERSFIELD CA
93308-1707
US

IV. Provider business mailing address

215 CHINA GRADE LOOP
BAKERSFIELD CA
93308-1707
US

V. Phone/Fax

Practice location:
  • Phone: 661-393-2331
  • Fax: 661-393-6284
Mailing address:
  • Phone: 661-393-2331
  • Fax: 661-393-6284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG41135
License Number StateCA

VIII. Authorized Official

Name: GREGORY A STAINER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-393-2331