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General NPI Number Information
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NPI Number | 1750696597
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Entity Type | Organization
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Legal Business Name | LUKE STILLWELL OPTOMETRIST, P.C.
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 1050 REGIONAL PARK RD
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City | LEBANON
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State | VA
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Zip | 24266-3712
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Country | US
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Telephone | 276-889-5828
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 911
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City | POUNDING MILL
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State | VA
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Zip | 24637-0911
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Country | US
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Telephone | 276-880-1277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS LUKE STILLWELL
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Credential | O.D.
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Telephone | 276-880-1277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001858
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License Number State | VA
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