Provider Demographics
NPI:1629244470
Name:RICHARD & MARCIA STAUTER
Entity Type:Organization
Organization Name:RICHARD & MARCIA STAUTER
Other - Org Name:FAMILY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:SCHULTE
Authorized Official - Last Name:STAUTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-352-4200
Mailing Address - Street 1:3545 W 12TH ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2545
Mailing Address - Country:US
Mailing Address - Phone:970-352-4200
Mailing Address - Fax:970-352-4278
Practice Address - Street 1:3545 W 12TH ST
Practice Address - Street 2:STE. 101
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2545
Practice Address - Country:US
Practice Address - Phone:970-352-4200
Practice Address - Fax:970-352-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1282152W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08012825Medicaid
CO0401890001Medicare NSC
CO08012825Medicaid
COC41353Medicare PIN