Provider Demographics
NPI:1033259957
Name:BASIC, STEPHEN THOMAS III (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:THOMAS
Last Name:BASIC
Suffix:III
Gender:M
Credentials:OD
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Mailing Address - Street 1:106 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4027
Mailing Address - Country:US
Mailing Address - Phone:434-409-2396
Mailing Address - Fax:
Practice Address - Street 1:1114 EMMET ST N STE D
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4841
Practice Address - Country:US
Practice Address - Phone:434-971-2020
Practice Address - Fax:434-295-1351
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001252152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist