Provider Demographics
NPI:1093747305
Name:STAATZ, STEPHANIE ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANNE
Last Name:STAATZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9904 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-1045
Mailing Address - Country:US
Mailing Address - Phone:816-407-9040
Mailing Address - Fax:
Practice Address - Street 1:6325 LEWIS DR STE 114
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-4501
Practice Address - Country:US
Practice Address - Phone:816-505-0100
Practice Address - Fax:816-505-2301
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R368604Medicare ID - Type Unspecified
MOU72448Medicare UPIN