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General NPI Number Information
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NPI Number | 1306031109
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Entity Type | Organization
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Legal Business Name | DR CRAIG STAAB AND ASSOCIATES P C
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 150 ALTAMA CONNECTOR
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City | BRUNSWICK
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State | GA
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Zip | 31525-2203
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Country | US
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Telephone | 812-262-6846
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Fax | 912-262-6102
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Provider Business Mailing Address
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Address Line | 150 ALTAMA CONNECTOR
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City | BRUNSWICK
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State | GA
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Zip | 31525-2203
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Country | US
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Telephone | 812-262-6846
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Fax | 912-262-6102
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CRAIG STAAB
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Credential | O.D.
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Telephone | 912-262-6846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1122
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License Number State | GA
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