Provider Demographics
NPI:1073691218
Name:STONE, JEAN A (OD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:STONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8465 EDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:GREERS FERRY
Mailing Address - State:AR
Mailing Address - Zip Code:72067
Mailing Address - Country:US
Mailing Address - Phone:501-825-8900
Mailing Address - Fax:501-825-8989
Practice Address - Street 1:8465 EDGEMONT RD
Practice Address - Street 2:
Practice Address - City:GREERS FERRY
Practice Address - State:AR
Practice Address - Zip Code:72067
Practice Address - Country:US
Practice Address - Phone:501-825-8900
Practice Address - Fax:501-825-8989
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2438152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U56720Medicare UPIN
5T078Medicare ID - Type Unspecified