Provider Demographics
NPI:1831242452
Name:STINSON, MARK RAYMOND (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:RAYMOND
Last Name:STINSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1658 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-6457
Mailing Address - Country:US
Mailing Address - Phone:909-793-2294
Mailing Address - Fax:909-425-2485
Practice Address - Street 1:7291 BOULDER AVE
Practice Address - Street 2:2D
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3389
Practice Address - Country:US
Practice Address - Phone:909-425-1212
Practice Address - Fax:909-425-2485
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6361152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist