Provider Demographics
NPI:1477541597
Name:STONE, THOMAS W (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:STONE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:220 N MCKEMY AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2651
Mailing Address - Country:US
Mailing Address - Phone:480-835-4472
Mailing Address - Fax:480-893-8172
Practice Address - Street 1:801 S MILTON RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7313
Practice Address - Country:US
Practice Address - Phone:928-213-1400
Practice Address - Fax:928-773-1463
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2586549Medicaid
MI2586549Medicaid