Provider Demographics
NPI:1003886821
Name:STINE, CHARLES W (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:STINE
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:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1360
Mailing Address - Country:US
Mailing Address - Phone:540-687-3634
Mailing Address - Fax:540-687-3378
Practice Address - Street 1:# 4 PENDLETON ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:VA
Practice Address - Zip Code:20117-0000
Practice Address - Country:US
Practice Address - Phone:540-687-3634
Practice Address - Fax:540-687-3378
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA320412OtherMAMSI
VA0694647OtherAETNA HMO
VA192987OtherBLUE CROSS BLUE SHIELD
VA412947OtherUNITED HEALTHCARE
VA009231919Medicaid
VA320412OtherALLIANCE
VA320412OtherALLIANCE
VA00X458C01Medicare PIN
VA412947OtherUNITED HEALTHCARE
VA320412OtherMAMSI