Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618000238 | VA |
NPI | 1003886821 |
---|---|
Provider Name | Dr. Charles W Stine |
First Address | Middleburg, VA 20118-1360 |
Second Address | Middleburg, VA 20117-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 31/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009231919 | (05) | VA |
0694647 | AETNA HMO (01) | VA |
192987 | BLUE CROSS BLUE SHIELD (01) | VA |
320412 | ALLIANCE (01) | VA |
320412 | MAMSI (01) | VA |
412947 | UNITED HEALTHCARE (01) | VA |
T78322 | (02) | VA |