Provider Demographics
NPI:1467401059
Name:STAPLETON, VERNON ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:ANTHONY
Last Name:STAPLETON
Suffix:
Gender:M
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:PO BOX 91630
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-1630
Mailing Address - Country:US
Mailing Address - Phone:863-660-3287
Mailing Address - Fax:
Practice Address - Street 1:6844 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2512
Practice Address - Country:US
Practice Address - Phone:813-715-0093
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL001973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist