Healthcare Provider Details

I. General information

NPI: 1699946822
Provider Name (Legal Business Name): STEPHEN SAMSON STONE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2008
Last Update Date: 03/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23660 INDUSTRIAL PARK DR SUITE 111
FARMINGTON HILLS MI
48335-2838
US

IV. Provider business mailing address

23660 INDUSTRIAL PARK DR SUITE 111
FARMINGTON HILLS MI
48335-2838
US

V. Phone/Fax

Practice location:
  • Phone: 248-478-0320
  • Fax:
Mailing address:
  • Phone: 248-478-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4901002410
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: