Healthcare Provider Details

I. General information

NPI: 1477541597
Provider Name (Legal Business Name): THOMAS W STONE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S MILTON RD
FLAGSTAFF AZ
86001-7313
US

IV. Provider business mailing address

220 N MCKEMY AVE
CHANDLER AZ
85226-2651
US

V. Phone/Fax

Practice location:
  • Phone: 928-213-1400
  • Fax: 928-773-1463
Mailing address:
  • Phone: 480-835-4472
  • Fax: 480-893-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2027
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: