Provider Demographics
NPI:1831295906
Name:STONE, SHANNON REBECCA (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:REBECCA
Last Name:STONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:REBECCA
Other - Last Name:MAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2200 FORT ROOTS DR
Mailing Address - Street 2:112LV/NLR
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1709
Mailing Address - Country:US
Mailing Address - Phone:501-257-3396
Mailing Address - Fax:501-257-3398
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:112 EY/NLR
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-3396
Practice Address - Fax:501-257-3398
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000198152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist