Provider Demographics
NPI:1184649204
Name:STONE, BLAIR (OD)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
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 1:7020 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6430
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-863-2862
Practice Address - Street 1:1001 WIDE WATERS PKWY
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7333
Practice Address - Country:US
Practice Address - Phone:919-861-2020
Practice Address - Fax:919-277-0854
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093U7OtherBLUECROSS
NC5904664Medicaid
NC5904664Medicaid