Provider Demographics
NPI:1982830659
Name:STONE, BRENDA (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:STONE
Other - Last Name:FERNANDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6420 S MACADAM AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3517
Mailing Address - Country:US
Mailing Address - Phone:503-244-8601
Mailing Address - Fax:503-244-3013
Practice Address - Street 1:9135 SW BARNES RD STE 961
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6699
Practice Address - Country:US
Practice Address - Phone:503-244-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD3775152W00000X
OR2892ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500675919Medicaid