Provider Demographics
NPI:1033213145
Name:STONE, TERESA L (OD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:STONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL STREET12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:978-345-7398
Mailing Address - Fax:978-353-0035
Practice Address - Street 1:5 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-856-9599
Practice Address - Fax:508-854-4998
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA793032OtherTUFTS HEALTH PLAN
MA0312584Medicaid
MA151572OtherHARVARD PILGRIM HEALTH CA
MA793032OtherTUFTS HEALTH PLAN
MAW17203Medicare PIN