Provider Demographics
NPI:1568801199
Name:MICHAEL STAGNER,M.D. P.C
Entity Type:Organization
Organization Name:MICHAEL STAGNER,M.D. P.C
Other - Org Name:STAGNER EYE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-753-2900
Mailing Address - Street 1:2403 N STOCKTON HILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4188
Mailing Address - Country:US
Mailing Address - Phone:928-753-2900
Mailing Address - Fax:928-753-2944
Practice Address - Street 1:2403 N STOCKTON HILL RD STE 1
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4188
Practice Address - Country:US
Practice Address - Phone:928-753-2900
Practice Address - Fax:928-753-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24627156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1720069982OtherNPI INDIVIDUAL
AZF58206Medicare UPIN