Provider Demographics
NPI:1578553616
Name:STONE, DEBRA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:MARIE
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 1:800 MT VERNON HWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4295
Mailing Address - Country:US
Mailing Address - Phone:770-804-1684
Mailing Address - Fax:
Practice Address - Street 1:800 MT VERNON HWY
Practice Address - Street 2:SUITE 125
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4295
Practice Address - Country:US
Practice Address - Phone:770-804-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001352152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00514709DMedicaid
GA00514709DMedicaid
GAU35287Medicare UPIN