Healthcare Provider Details

I. General information

NPI: 1093955262
Provider Name (Legal Business Name): TONYA CANNON STEWART, OD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WEST LAKEVIEW DRIVE
CLINTON MS
39056-5221
US

IV. Provider business mailing address

45 WEST LAKEVIEW DRIVE
CLINTON MS
39056-5221
US

V. Phone/Fax

Practice location:
  • Phone: 601-925-2020
  • Fax: 601-925-2010
Mailing address:
  • Phone: 601-925-2020
  • Fax: 601-925-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number640
License Number StateMS

VIII. Authorized Official

Name: DR. TONYA CANNON STEWART
Title or Position: OWNER
Credential: OD
Phone: 601-925-2020