=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982654216
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID RICHARD STAGER JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2006
-----------------------------------------------------
Last Update Date | 07/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3801 W 15TH ST A110
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-4737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-758-0625
-----------------------------------------------------
Fax | 972-964-5725
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3801 W 15TH ST A110
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-4737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-758-0625
-----------------------------------------------------
Fax | 972-964-5725
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | J1572
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------