Provider Demographics
NPI:1992868269
Name:GREGORY A STAINER MD FACS A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GREGORY A STAINER MD FACS A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:SOUTHWEST EYE CARE AND LASER MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-393-2331
Mailing Address - Street 1:215 CHINA GRADE LOOP
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-1707
Mailing Address - Country:US
Mailing Address - Phone:661-393-2331
Mailing Address - Fax:661-393-6284
Practice Address - Street 1:215 CHINA GRADE LOOP
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-1707
Practice Address - Country:US
Practice Address - Phone:661-393-2331
Practice Address - Fax:661-393-6284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152W00000X
CAG41135207W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ37940ZMedicaid
CA00G411350Medicare PIN
CAZZZ25824ZMedicare PIN
CA0243420001Medicare NSC
CACH4309Medicare PIN
CAZZZ37940ZMedicaid