Provider Demographics
NPI:1811292261
Name:CHRISTOPHER A STANSBURY OD PLLC
Entity type:Organization
Organization Name:CHRISTOPHER A STANSBURY OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:STANSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-343-3937
Mailing Address - Street 1:500 LEE ST E
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-3200
Mailing Address - Country:US
Mailing Address - Phone:304-343-3937
Mailing Address - Fax:304-343-1590
Practice Address - Street 1:500 LEE ST E
Practice Address - Street 2:SUITE 150
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-3200
Practice Address - Country:US
Practice Address - Phone:304-343-3937
Practice Address - Fax:304-343-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1017-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1017-ODOtherLICENSE
WVV05508OtherUPIN
WVV05508OtherUPIN