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General NPI Number Information
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NPI Number | 1558484261
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Entity Type | Organization
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Legal Business Name | PEDIATRIC OPHTHALMOLOGY PA
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 6200 W PARKER RD # 508
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City | PLANO
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State | TX
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Zip | 75093-7939
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Country | US
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Telephone | 972-981-8389
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Fax | 972-981-3242
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Provider Business Mailing Address
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Address Line | 8222 DOUGLAS AVE STE 400
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City | DALLAS
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State | TX
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Zip | 75225-5923
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Country | US
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Telephone | 214-369-6434
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Fax | 214-696-6273
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID R STAGER SR.
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Credential | MD
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Telephone | 214-369-6434
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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 |
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License Number State |
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