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NPI Code Detail

MEDICARE: DR. ROBERT WILLIAM STETEKLUH O.D.

MEDICARE: DR. ROBERT WILLIAM STETEKLUH O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist0618001004VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
106-1711971OTHERVATAX ID #

General Provider Information

NPI Number : 1164576005
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT WILLIAM STETEKLUH O.D.
Provider Business Mailing Address
First Line : 6301 LITTLE RIVER TPKE
Second Line : STE 110
City : ALEXANDRIA
State : VA
Zip : 22312-5044
Country : US
Telephone Number : 703-524-2800
Fax Number : 703-524-9493
Provider Business Practice Location Address
First Line : 4238 WILSON BLVD
Second Line : SUITE 3140
City : ARLINGTON
State : VA
Zip : 22203-1823
Country : US
Telephone Number : 703-524-2800
Fax Number : 703-524-9493
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 12/03/2018

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