Provider Demographics
NPI:1780742270
Name:BENJAMIN D STONE INC
Entity type:Organization
Organization Name:BENJAMIN D STONE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-283-4788
Mailing Address - Street 1:340 3RD ST
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649
Mailing Address - Country:US
Mailing Address - Phone:218-283-4788
Mailing Address - Fax:
Practice Address - Street 1:340 3RD ST
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649
Practice Address - Country:US
Practice Address - Phone:218-283-4788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1583332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C9925TOtherBLUE CROSS
MNMN1583OtherEYE MED
MN2100595OtherMEDICA
MN581223200Medicaid
MN264685TOtherBLUE CROSS
MN111184OtherUCARE
MN16255OtherSPECTERA
MN2222415OtherMEDICA
MN52902OtherDAVIS VISION
MN0209680001Medicare NSC
MN2100595OtherMEDICA
T66176Medicare UPIN