Provider Demographics
NPI:1740244862
Name:STAUNTON EYE CLINIC PLC
Entity Type:Organization
Organization Name:STAUNTON EYE CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STATHOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:540-885-8186
Mailing Address - Street 1:2008 N AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2435
Mailing Address - Country:US
Mailing Address - Phone:540-886-7501
Mailing Address - Fax:540-886-5895
Practice Address - Street 1:2008 N AUGUSTA ST
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9280651Medicaid
VA9280651Medicaid