Provider Demographics
NPI:1649456476
Name:STONE, GARY L (OPTICIAN)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:STONE
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3421
Mailing Address - Country:US
Mailing Address - Phone:803-327-3111
Mailing Address - Fax:803-327-9611
Practice Address - Street 1:1565 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3421
Practice Address - Country:US
Practice Address - Phone:803-327-3111
Practice Address - Fax:803-327-9611
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC843156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician