Organization
PEDIATRIC OPHTHALMOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID R STAGER SR. MD (PRESIDENT)
(214) 369-6434
Entity
Organization
Contact information
Practice address
1631 LANCASTER DR, # 200, GRAPEVINE, TX 76051-3585
(817) 329-5433
(817) 329-5532
Mailing address
8222 DOUGLAS AVE, STE 400, DALLAS, TX 75225-5923
(214) 369-6434
(214) 696-6273
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130345509
—
TX
Enumeration date
04/23/2007
Last updated
09/08/2010
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