Provider Demographics
NPI:1770853004
Name:LOCUST GROVE EYE CARE PLLC
Entity Type:Organization
Organization Name:LOCUST GROVE EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:540-972-6786
Mailing Address - Street 1:4207 GERMANNA HWY STE C
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-2040
Mailing Address - Country:US
Mailing Address - Phone:540-972-6786
Mailing Address - Fax:540-972-6788
Practice Address - Street 1:4207 GERMANNA HWY STE C
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-2040
Practice Address - Country:US
Practice Address - Phone:540-972-6786
Practice Address - Fax:540-972-6788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty