Provider Demographics
NPI:1801059886
Name:STEWART, JOLENE DIANA (OD)
Entity type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:DIANA
Last Name:STEWART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JOLENE
Other - Middle Name:DIANA
Other - Last Name:HANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:742 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1266
Mailing Address - Country:US
Mailing Address - Phone:937-467-1074
Mailing Address - Fax:937-615-9987
Practice Address - Street 1:1300 E ASH ST
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4100
Practice Address - Country:US
Practice Address - Phone:937-615-9982
Practice Address - Fax:937-615-9987
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5794152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist