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NPI Code Detail

MEDICARE: DR. SCOTT DALE STAATZ O.D.

MEDICARE: DR. SCOTT DALE STAATZ O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristTO3394MO

General Provider Information

NPI Number : 1801810189
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT DALE STAATZ O.D.
Provider Business Mailing Address
First Line : 2707 MILLER ST
Second Line :
City : BETHANY
State : MO
Zip : 64424-2704
Country : US
Telephone Number : 660-425-8116
Fax Number : 660-425-3418
Provider Business Practice Location Address
First Line : 2707 MILLER ST
Second Line :
City : BETHANY
State : MO
Zip : 64424-2704
Country : US
Telephone Number : 660-425-8116
Fax Number : 660-425-3418
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/08/2007

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