Provider Demographics
NPI:1154486975
Name:STONEBURNER, JON (OD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:STONEBURNER
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 1:6509 BLOWLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231
Mailing Address - Country:US
Mailing Address - Phone:941-924-7508
Mailing Address - Fax:941-924-0465
Practice Address - Street 1:8201 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2966
Practice Address - Country:US
Practice Address - Phone:941-924-7508
Practice Address - Fax:941-924-0465
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC936152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU17884Medicare UPIN