Provider Demographics
NPI:1588706428
Name:STILL, DAVID LEE (OD, PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:STILL
Suffix:
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9841 HOLLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7117
Mailing Address - Country:US
Mailing Address - Phone:850-479-2591
Mailing Address - Fax:
Practice Address - Street 1:6001 FARREL ROAD
Practice Address - Street 2:USAARL
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-0577
Practice Address - Country:US
Practice Address - Phone:334-255-0369
Practice Address - Fax:334-255-6977
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist