1477602910 NPI number — ERIC A. STAFFIER, OD, PC

Table of content: (NPI 1477602910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477602910 NPI number — ERIC A. STAFFIER, OD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERIC A. STAFFIER, OD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477602910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 GALLERIA MALL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAUNTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02780-6913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-824-3208
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 GALLERIA MALL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAUNTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02780-6913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-824-3208
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STAFFIER
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-824-3208

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4332 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3877807 . This is a "AETNA HMO ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7046675 . This is a "AETNA PPO ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W16330 . This is a "BCBS OF MA PROVIDER ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1483638 . This is a "CIGNA ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: MA4332 . This is a "EYEMED ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W20381 . This is a "BCBS OF MA GROUP ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 410201 . This is a "BLUE CHIP OF RI ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 29127-3 . This is a "BCBS OF RI ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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