Individual
DR. STEVE LUTTRELL SULLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
104 GIN OAKS CT, MADISON, AL 35758-1736
(256) 464-6670
(256) 464-6671
Mailing address
104 GIN OAKS CT, MADISON, AL 35758-1736
(256) 464-6670
(256) 464-6671
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-761-TA-167
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051525296
—
AL
01
—
51525294
BCBS OF ALABAMA PROVIDER
AL
01
—
51525296
BCBS OF ALABAMA PROVIDER
AL
01
—
G900
MEDICARE GROUP PROVIDER #
AL
01
—
K232
MEDICARE GROUP PROVIDER #
AL
Enumeration date
07/27/2005
Last updated
11/14/2007
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