Organization
CHARLES W STINE OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDREA CHANEL KOVAK (OFFICE MANAGER)
(540) 687-3634
Entity
Organization
Contact information
Practice address
4 PENDLETON ST, MIDDLEBURG, VA 20117
(540) 687-3634
(540) 687-3378
Mailing address
PO BOX 1360, MIDDLEBURG, VA 20118-1360
(540) 687-3634
(540) 687-3378
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
0618000238
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009231919
—
VA
01
—
0694647
AETNA HMO
VA
01
—
192987
BLUECROSS BLUESHIELD
VA
01
—
320412
MAMSI
VA
01
—
412947
UNITED HEALTHCARE
VA
Enumeration date
05/11/2007
Last updated
07/07/2008
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