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General NPI Number Information
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NPI Number | 1902627979
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Entity Type | Organization
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Legal Business Name | PAUL B STAUDER
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 101 E DELAWARE ST STE C
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City | FAIRFIELD
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State | IL
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Zip | 62837-2171
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Country | US
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Telephone | 618-842-6516
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Fax | 618-842-6061
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Provider Business Mailing Address
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Address Line | PO BOX 506
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City | FAIRFIELD
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State | IL
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Zip | 62837-0506
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Country | US
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Telephone | 618-842-6516
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Fax | 618-842-6061
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL STAUDER
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Credential | OD
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Telephone | 618-842-6516
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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 |
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License Number State |
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