Individual
DR. JOHN A STAVRAKIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
701 GRAND CENTRAL AVE, VIENNA, WV 26105
(304) 428-0390
Mailing address
701 GRAND CENTRAL AVE, VIENNA, WV 26105
(304) 428-0390
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
875OD
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0149633000
—
WV
Enumeration date
05/02/2006
Last updated
07/08/2007
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