Provider Demographics
NPI:1205869450
Name:PARTAIN, CARL STANLEY (OD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:STANLEY
Last Name:PARTAIN
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 1:5 AUGUSTA CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-1860
Mailing Address - Country:US
Mailing Address - Phone:540-463-2611
Mailing Address - Fax:
Practice Address - Street 1:1233 N LEE HWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-3307
Practice Address - Country:US
Practice Address - Phone:540-463-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601001022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9236023Medicaid