Provider Demographics
NPI:1609051259
Name:ROSEMARY F DETMER STONE OD
Entity Type:Organization
Organization Name:ROSEMARY F DETMER STONE OD
Other - Org Name:A NEW VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DETMER STONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-646-8592
Mailing Address - Street 1:14385 SW ALLEN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4429
Mailing Address - Country:US
Mailing Address - Phone:503-646-8592
Mailing Address - Fax:503-526-3989
Practice Address - Street 1:14385 SW ALLEN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4429
Practice Address - Country:US
Practice Address - Phone:503-646-8592
Practice Address - Fax:503-526-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2568ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========OtherTAX ID
OR=========OtherTAX ID