Provider Demographics
NPI:1902875792
Name:ENOCHS, STEPHEN MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARK
Last Name:ENOCHS
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 1:3575 BRIDGE RD STE 19
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1844
Mailing Address - Country:US
Mailing Address - Phone:757-638-2015
Mailing Address - Fax:757-638-2010
Practice Address - Street 1:3575 BRIDGE RD STE 19
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1844
Practice Address - Country:US
Practice Address - Phone:757-638-2015
Practice Address - Fax:757-638-2010
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010419042Medicaid
VA58739OtherOPTIMA HEALTH
VA294202OtherVA BCBS
VA58739OtherOPTIMA HEALTH
VA010419042Medicaid
VA294202OtherVA BCBS