Provider Demographics
NPI:1275528150
Name:STORY, L. WOODROW JR (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:L.
Middle Name:WOODROW
Last Name:STORY
Suffix:JR
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11216 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5011
Mailing Address - Country:US
Mailing Address - Phone:804-740-2303
Mailing Address - Fax:804-740-2303
Practice Address - Street 1:11216 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-5011
Practice Address - Country:US
Practice Address - Phone:804-740-2303
Practice Address - Fax:804-740-2303
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601000655152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9203192Medicaid
VAT21311Medicare UPIN
VA410001143Medicare PIN
VA0907500001Medicare NSC