Provider Demographics
NPI:1942207717
Name:STINE, DAVID MORRIS (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MORRIS
Last Name:STINE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 WARRIOR CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1248
Mailing Address - Country:US
Mailing Address - Phone:937-836-4522
Mailing Address - Fax:
Practice Address - Street 1:5419 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3454
Practice Address - Country:US
Practice Address - Phone:937-278-0675
Practice Address - Fax:937-278-9535
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3003T1469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0228980Medicaid
OH0228980Medicaid
OHT46678Medicare UPIN
OHST0404032Medicare ID - Type UnspecifiedMEDICARE
OH0404032Medicare PIN