Healthcare Provider Details

I. General information

NPI: 1437562592
Provider Name (Legal Business Name): SAMANTHA T STAHR OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA L TRIPLETT OD

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 MEADE PKWY
SUFFOLK VA
23434-4259
US

IV. Provider business mailing address

2016 MEADE PARKWAY
SUFFOLK VA
23434
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-1533
  • Fax: 757-543-9659
Mailing address:
  • Phone: 757-539-1533
  • Fax: 757-539-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002319
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: