Provider Demographics
NPI:1457311375
Name:STATHOS, JOHN A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:STATHOS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2010 N AUGUSTA ST
Mailing Address - Street 2:STAUNTON EYE CLINIC PLC
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2435
Mailing Address - Country:US
Mailing Address - Phone:540-885-8186
Mailing Address - Fax:540-886-5895
Practice Address - Street 1:2010 N AUGUSTA ST
Practice Address - Street 2:STAUNTON EYE CLINIC PLC
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2435
Practice Address - Country:US
Practice Address - Phone:540-885-8186
Practice Address - Fax:540-886-5895
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-07-29
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Provider Licenses
StateLicense IDTaxonomies
VA0101032974207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006307868Medicaid
C36631Medicare UPIN
VA006307868Medicaid