MEDICARE: DR. STEVE LUTTRELL SULLINS 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
1	152W00000X	Optometrist	S-761-TA-167	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	K232	OTHER	AL	MEDICARE GROUP PROVIDER #
3	G900	OTHER	AL	MEDICARE GROUP PROVIDER #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	51525294	OTHER	AL	BCBS OF ALABAMA PROVIDER
5	51525296	OTHER	AL	BCBS OF ALABAMA PROVIDER

General Provider Information

NPI Number	:	1740280205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVE LUTTRELL SULLINS O.D.

Provider Business Mailing Address
First Line	:	104 GIN OAKS CT
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-1736
Country	:	US
Telephone Number	:	256-464-6670
Fax Number	:	256-464-6671

Provider Business Practice Location Address
First Line	:	104 GIN OAKS CT
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-1736
Country	:	US
Telephone Number	:	256-464-6670
Fax Number	:	256-464-6671

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	11/14/2007

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