Healthcare Provider Details

I. General information

NPI: 1972917573
Provider Name (Legal Business Name): NATHAN STAHR O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N MAIN ST
SUFFOLK VA
23434
US

IV. Provider business mailing address

2016 MEADE PKWY
SUFFOLK VA
23434
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-5291
  • Fax: 757-539-8505
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 Number0618002331
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: