Davis Marshall Staley

Primary specialty

OptometristTaxonomy code 152W00000X

License

106884 Issued in AK

Practice address

330 W Dimond Blvd
Anchorage, AK 99515-1903

Phone

(907) 267-7102

Fax

(907) 349-7039

NPI assigned

Feb 2, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Alaska Native Tribal Health Consortium

  • General Acute Care Hospital
  • Anchorage, AK
  • NPI 1437189339

  Multi-Specialty, TX

  Medicare reassignment NPD
• Southcentral Foundation

  • Multi-Specialty Clinic/Center
  • Anchorage, AK
  • NPI 1083660815
  NPD (past)
• Southcentral Foundation

  • Multi-Specialty Clinic/Center
  • Anchorage, AK
  • NPI 1255881637
  NPD (past)
• Southcentral Foundation

  • Multi-Specialty Clinic/Center
  • Wasilla, AK
  • NPI 1386680056
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1497051858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 W DIMOND BLVD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995151903",
            "telephone_number": "907-267-7102",
            "fax_number": "907-349-7039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 W DIMOND BLVD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995151903",
            "telephone_number": "907-267-7102",
            "fax_number": "907-349-7039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 S Knik Goose Bay Rd",
            "address_purpose": "LOCATION",
            "city": "Wasilla",
            "state": "AK",
            "postal_code": "99654",
            "country_code": "US",
            "telephone_number": "907-631-7604",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3235 S Leavitt St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606086016",
            "country_code": "US",
            "telephone_number": "520-456-6030",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3235 S Leavitt St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606086016",
            "country_code": "US",
            "telephone_number": "520-456-6030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STALEY",
        "first_name": "DAVIS",
        "middle_name": "MARSHALL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-02-02",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "AK",
            "license": "106884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "920086076",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna M. Stafford, LCSW
• Sandy Marie Stagelman, RN
• Jackson Rucker Staggers, MD
• Jody Antoinette Stahl
• Kimberly Stahlnecker, CCC-SLP
• Thomas Staley
• Dwight Briggs Stallman, D.O.
• Yannick Malcolm Stallworth
• Joseph Micah Stam
• Kali M Staman, MD

• Optometrist in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Optometrist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.