Provider Demographics
NPI:1306880257
Name:STAAB, ALBERT J (OD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:J
Last Name:STAAB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 ROUTE 70 E
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1747
Mailing Address - Country:US
Mailing Address - Phone:856-985-0066
Mailing Address - Fax:856-985-8104
Practice Address - Street 1:65 ROUTE 70 E STE 3
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1747
Practice Address - Country:US
Practice Address - Phone:856-596-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00598300152W00000X, 152WS0006X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00401966OtherRAILROAD MEDICARE PROVIDER TRANSACTION NUMBER PTAN
V06932Medicare UPIN
095276Medicare ID - Type Unspecified