Provider Demographics
NPI:1316032154
Name:STAGER, CHARMION LYNN (OD)
Entity Type:Individual
Prefix:
First Name:CHARMION
Middle Name:LYNN
Last Name:STAGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHARMION
Other - Middle Name:LYNN
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD,
Mailing Address - Street 1:10172 CLEAR SKY DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9898
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9741 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3035
Practice Address - Country:US
Practice Address - Phone:317-869-0308
Practice Address - Fax:317-869-0975
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002811B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44193Medicare UPIN
INU64954Medicare UPIN