Organization
STEPHEN T BASIC III OD AND ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN THOMAS BASIC III O.D. (OWNER)
(434) 409-2396
Entity
Organization
Contact information
Practice address
1114 EMMET ST N STE D, CHARLOTTESVILLE, VA 22903-4841
(434) 971-2020
Mailing address
106 VILLAGE CT, CHARLOTTESVILLE, VA 22903-4027
(434) 409-2396
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001252
VA
Other
Enumeration date
10/29/2012
Last updated
12/18/2012
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