Healthcare Provider Details

I. General information

NPI: 1871578476
Provider Name (Legal Business Name): JAMES E. STAFFORD O D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CLARA BARTON ST
DANSVILLE NY
14437-1516
US

IV. Provider business mailing address

28 CLARA BARTON ST
DANSVILLE NY
14437-1516
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-8812
  • Fax:
Mailing address:
  • Phone: 585-335-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number004195
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number004195
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: