Healthcare Provider Details

I. General information

NPI: 1124080080
Provider Name (Legal Business Name): STEPHEN CAULEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 NORTHSIDE DR E
STATESBORO GA
30458-1002
US

IV. Provider business mailing address

1950 OLD GALLOWS RD STE 520
VIENNA VA
22182-3970
US

V. Phone/Fax

Practice location:
  • Phone: 912-764-9147
  • Fax: 912-764-3250
Mailing address:
  • Phone: 703-847-8899
  • Fax: 866-795-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT001630
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: