DR. KELLY STATON (NPI# 1548302649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548302649 |
| Entity Type | Individual |
| Full Name | DR. KELLY STATON |
| Credential | O.D. |
| Practice Address |
320 Petaluma Blvd S Petaluma CA 94952-4245 |
| Mailing Address |
124 Jagle St Cotati CA 94931-5375 |
| Practice Telephone | 7077628643 |
| Mailing Telephone | 7077926783 |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 10012T | CA | Eye and Vision Services Providers |
| Street Address |
320 PETALUMA BLVD S |
| City | PETALUMA |
| State | CA |
| Zip Code | 94952-4245 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659372365 | Karen Ann Griffith | Optometrist | 320 Petaluma Blvd S, Petaluma, CA 94952-4245 | 2005-08-03 |
| 1992944185 | Karen Griffith Od A Professional Optometry Corporation | Optometrist | 320 Petaluma Blvd S, Petaluma, CA 94952-4245 | 2009-02-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114587680 | Benjamin R Idarius | Behavior Technician | 101 H St. Ste. L, Petaluma, CA 94952 | 2019-06-17 |
| 1518457159 | Kyleen Joan Romero | Behavioral Analyst | 25 Graylawn Ave, Petaluma, CA 94952 | 2018-05-17 |
| 1437647526 | John Scruggs | Behavior Technician | 301 H St. Suit L, Petaluma, CA 94952 | 2018-04-25 |
| 1811404684 | Brief and Strategic Counseling Service | Counselor | 843 Chardonnay Cir., Petaluma, CA 94952 | 2018-01-03 |
| 1730638396 | Jennifer Lee Sloan | Acupuncturist | 517 Hayes Lane, Petaluma, CA 94952 | 2016-09-23 |
| 1982057295 | Elene Hwa-yihg Chung | Acupuncturist | 130 Graylawn Ave.,#f, Petaluma, CA 94952 | 2016-07-21 |
| 1457773624 | Lisa Hirsch Cordeiro | Marriage & Family Therapist | 700 Sixth Street, Petaluma, CA 94952 | 2014-01-07 |
| 1811271075 | Jacques Philippe Archer | Massage Therapist | 131b Kentucky St., Petaluma, CA 94952 | 2011-10-06 |
| 1477841609 | Karna Licia Dawson | Social Worker | 205 Keller St., Petaluma, CA 94952 | 2011-07-21 |
| 1497051783 | Melissa Beth Wilson | Acupuncturist | 155a Kentucky Street, Petaluma, CA 94952 | 2011-02-03 |
| Find all providers in zip 94952 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366978363 | Eye Care Institute, A Medical Corporation | Optometrist | 1383 N Mcdowell Blvd Ste 100, Petaluma, CA 94954-1190 | 2017-05-11 |
| 1649530536 | Taras Litvin, O.d., Inc. | Optometrist | 921 Transport Way, Suite #18, Petaluma, CA 94954-1461 | 2012-05-24 |
| 1740321710 | Jean Sterrett Brennan | Optometrist | 119 C St, Petaluma, CA 94952-3069 | 2007-02-10 |
| 1699708727 | Gerald Thomas Pittler | Optometrist | 855 Lakeville St Ste 102, Petaluma, CA 94952-7328 | 2006-07-09 |
| 1518939156 | Richard Cole Aston | Optometrist | 345b S Mcdowell Blvd, Petaluma, CA 94954-3507 | 2006-02-07 |
| 1417949942 | Gordon Miles Wong | Optometrist | 66 E Washington St, Petaluma, CA 94952-3165 | 2005-08-19 |
| 1659372365 | Karen Ann Griffith | Optometrist | 320 Petaluma Blvd S, Petaluma, CA 94952-4245 | 2005-08-03 |
| 1437159803 | Ronald Lee Harris | Optometrist | 1225 North Mcdowell Blvd., Petaluma, CA 94954-1112 | 2005-07-28 |
| 1619344918 | Darwin C Tsang | Optometrist | 401 Kenilworth Dr, Inside Target Optical, Petaluma, CA 94952-3400 | 2015-08-21 |
| 1578990552 | Petaluma Eye Care Optometric Associates, Inc. | Optometrist | 1225 N Mcdowell Blvd, Petaluma, CA 94954-1112 | 2013-10-04 |
| Find all providers in PETALUMA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.