Healthcare Provider Details

I. General information

NPI: 1740244862
Provider Name (Legal Business Name): STAUNTON EYE CLINIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 N AUGUSTA ST
STAUNTON VA
24401-2435
US

IV. Provider business mailing address

2008 N AUGUSTA ST
STAUNTON VA
24401-2435
US

V. Phone/Fax

Practice location:
  • Phone: 540-885-8186
  • Fax: 540-886-5895
Mailing address:
  • Phone: 540-886-7501
  • Fax: 540-886-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: JOHN A STATHOS JR.
Title or Position: OWNER
Credential: MD
Phone: 540-885-8186