Provider Demographics
NPI:1194986869
Name:TODD G STAGNER OD PLLC
Entity type:Organization
Organization Name:TODD G STAGNER OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:G
Authorized Official - Last Name:STAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-963-5640
Mailing Address - Street 1:228 N HELMER RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49037-7931
Mailing Address - Country:US
Mailing Address - Phone:269-963-5640
Mailing Address - Fax:
Practice Address - Street 1:228 N HELMER RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037-7931
Practice Address - Country:US
Practice Address - Phone:269-963-5640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900A312400OtherBLUE CROSS BLUE SHIELD
MI900A312400OtherBLUE CROSS BLUE SHIELD
MIU32328Medicare UPIN