Provider Demographics
NPI:1871578476
Name:STAFFORD, JAMES E (O D)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CLARA BARTON ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-1516
Mailing Address - Country:US
Mailing Address - Phone:585-335-8812
Mailing Address - Fax:
Practice Address - Street 1:28 CLARA BARTON ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-1516
Practice Address - Country:US
Practice Address - Phone:585-335-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004195152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0605920001Medicare NSC
17902BMedicare ID - Type Unspecified
U02390Medicare UPIN