Provider Demographics
NPI:1821188749
Name:STAUTER, MARCIA SCHULTE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:SCHULTE
Last Name:STAUTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08012825Medicaid
CO08012825Medicaid
COT95493Medicare UPIN
CO0401890001Medicare NSC