Provider Demographics
NPI:1801871223
Name:DETMER STONE, ROSEMARY F (OD)
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:F
Last Name:DETMER STONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4655 SW GRIFFITH DR
Mailing Address - Street 2:#165
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-8728
Mailing Address - Country:US
Mailing Address - Phone:503-646-8592
Mailing Address - Fax:503-526-3989
Practice Address - Street 1:4655 SW GRIFFITH DR
Practice Address - Street 2:#165
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-8728
Practice Address - Country:US
Practice Address - Phone:503-646-8592
Practice Address - Fax:503-526-3989
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2568AT152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU62578Medicare UPIN
OR108384Medicare ID - Type Unspecified