Provider Demographics
NPI:1740280205
Name:SULLINS, STEVE LUTTRELL (OD)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:LUTTRELL
Last Name:SULLINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GIN OAKS CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1736
Mailing Address - Country:US
Mailing Address - Phone:256-464-6670
Mailing Address - Fax:256-464-6671
Practice Address - Street 1:104 GIN OAKS CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1736
Practice Address - Country:US
Practice Address - Phone:256-464-6670
Practice Address - Fax:256-464-6671
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-761-TA-167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051525296Medicaid
ALK232OtherMEDICARE GROUP PROVIDER #
ALG900OtherMEDICARE GROUP PROVIDER #
AL51525294OtherBCBS OF ALABAMA PROVIDER
AL51525296OtherBCBS OF ALABAMA PROVIDER
AL051525296Medicare ID - Type Unspecified
ALG900OtherMEDICARE GROUP PROVIDER #
AL051525296Medicaid