Healthcare Provider Details

I. General information

NPI: 1457311375
Provider Name (Legal Business Name): JOHN A STATHOS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 N AUGUSTA ST STAUNTON EYE CLINIC PLC
STAUNTON VA
24401-2435
US

IV. Provider business mailing address

2010 N AUGUSTA ST STAUNTON EYE CLINIC PLC
STAUNTON VA
24401-2435
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101032974
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: