Provider Demographics
NPI:1881818276
Name:STONE, JENNIFER LEE (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:STONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 PROVIDENCE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2976
Mailing Address - Country:US
Mailing Address - Phone:410-486-1010
Mailing Address - Fax:
Practice Address - Street 1:6115 FALLS RD
Practice Address - Street 2:SUITE 333
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2219
Practice Address - Country:US
Practice Address - Phone:410-377-2422
Practice Address - Fax:410-377-7960
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2036152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00471983OtherMEDICARE RAILROAD CARRIER
MDT932002OtherFEDERAL BC/BS
MD206012OtherADVANTICA
MD111143OtherGEISSINGER HEALTH
MD933709OtherBLOCK VISION
MD58544OtherDAVIS VISION
MD91062601OtherCAREFIRST BC.BS
MDT932002OtherFEDERAL BC/BS
MD933709OtherBLOCK VISION