Healthcare Provider Details

I. General information

NPI: 1003886821
Provider Name (Legal Business Name): CHARLES W STINE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

# 4 PENDLETON ST
MIDDLEBURG VA
20117-0000
US

IV. Provider business mailing address

PO BOX 1360
MIDDLEBURG VA
20118-1360
US

V. Phone/Fax

Practice location:
  • Phone: 540-687-3634
  • Fax: 540-687-3378
Mailing address:
  • Phone: 540-687-3634
  • Fax: 540-687-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000238
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: