Healthcare Provider Details

I. General information

NPI: 1609051259
Provider Name (Legal Business Name): ROSEMARY F DETMER STONE OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14385 SW ALLEN BLVD STE 102
BEAVERTON OR
97005-4429
US

IV. Provider business mailing address

14385 SW ALLEN BLVD STE 102
BEAVERTON OR
97005-4429
US

V. Phone/Fax

Practice location:
  • Phone: 503-646-8592
  • Fax: 503-526-3989
Mailing address:
  • Phone: 503-646-8592
  • Fax: 503-526-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2568ATI
License Number StateOR

VIII. Authorized Official

Name: DR. ROSEMARY F DETMER STONE
Title or Position: OWNER
Credential: O.D.
Phone: 503-646-8592