Individual
DR. MARK D STOVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
120 W MARKET ST, LOUISVILLE, KY 40202-1332
(502) 585-2020
(502) 585-1797
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1147DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410048660
RAILROAD MEDICARE
KY
05
—
77011476
—
KY
Enumeration date
05/30/2006
Last updated
12/22/2022
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