NPIMap

Organization Active NPI

Pediatric Ophthalmology PA

  • Ophthalmology Physician
  • Grapevine, TX
National Provider Identifier
1619195047
Registry record updated Sep 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PEDIATRIC OPHTHALMOLOGY PA
Practice address
1631 Lancaster Dr
# 200
Grapevine, TX 76051-3585
Phone
(817) 329-5433
Fax
(817) 329-5532
NPI assigned
Apr 23, 2007
Last updated
Sep 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2010

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

Authorized official

Name
David R Stager Sr., MDNPI 1982654216
Title
President
Phone
(214) 369-6434

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

1631 Lancaster Dr
# 200
Grapevine, TX 76051-3585

Mailing address

8222 Douglas Ave
Ste 400
Dallas, TX 75225-5923
Phone (214) 369-6434

Other identifiers 1

IdentifierTypeStateIssuer
130345509MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080509000073 TX Part B Supplier - Clinic/Group Practice 9739147158 Receives reassigned benefits from 1 practitioner
Practice locations: Grapevine, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Ophthalmology PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

7150 Greenville Ave
Ste 305
Dallas, TX 75231
Phone (214) 265-1111

8201 Preston Rd
#140A
Dallas, TX 75225
Phone (214) 369-6434

1631 Lancaster Dr
Ste 200
Grapevine, TX 76051
Phone (817) 329-5433

1643 Lancaster Dr
Ste 306
Grapevine, TX 76051
Phone (817) 310-0107

3900 W 15th St
Ste 406
Plano, TX 75075
Phone (972) 758-0625

6200 W Parker Rd
Ste 508
Plano, TX 75093
Phone (972) 981-8389

610 N Coit Rd
Ste 2120
Richardson, TX 75080
Phone (972) 331-9500

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283904000000",
    "number": "1619195047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8222 DOUGLAS AVE",
            "address_2": "STE 400",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752255923",
            "telephone_number": "214-369-6434",
            "fax_number": "214-696-6273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 LANCASTER DR",
            "address_2": "# 200",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513585",
            "telephone_number": "817-329-5433",
            "fax_number": "817-329-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC OPHTHALMOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2010-09-08",
        "status": "A",
        "authorized_official_last_name": "STAGER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-369-6434",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130345509",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grapevine, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.