Provider Demographics
NPI:1205961687
Name:STIMPSON, RANAN BOYETT (OD)
Entity type:Individual
Prefix:DR
First Name:RANAN
Middle Name:BOYETT
Last Name:STIMPSON
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 1:3700 LARGENT WAY NW
Mailing Address - Street 2:STE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1670
Mailing Address - Country:US
Mailing Address - Phone:770-422-2021
Mailing Address - Fax:770-514-9603
Practice Address - Street 1:3700 LARGENT WAY NW
Practice Address - Street 2:STE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1670
Practice Address - Country:US
Practice Address - Phone:770-422-2021
Practice Address - Fax:770-514-9603
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1294T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU25496Medicare UPIN
GA41ZCCGTMedicare ID - Type Unspecified