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General NPI Number Information
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NPI Number | 1457311375
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Entity Type | Individual
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Provider Name | JOHN A STATHOS JR. MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 2010 N AUGUSTA ST STAUNTON EYE CLINIC PLC
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City | STAUNTON
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State | VA
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Zip | 24401-2435
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Country | US
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Telephone | 540-885-8186
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Fax | 540-886-5895
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Provider Business Mailing Address
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Address Line | 2010 N AUGUSTA ST STAUNTON EYE CLINIC PLC
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City | STAUNTON
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State | VA
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Zip | 24401-2435
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Country | US
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Telephone | 540-885-8186
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Fax | 540-886-5895
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101032974
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License Number State | VA
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