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General NPI Number Information
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NPI Number | 1093955262
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Entity Type | Organization
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Legal Business Name | TONYA CANNON STEWART, OD, PLLC
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 45 WEST LAKEVIEW DRIVE
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City | CLINTON
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State | MS
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Zip | 39056-5221
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Country | US
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Telephone | 601-925-2020
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Fax | 601-925-2010
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Provider Business Mailing Address
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Address Line | 45 WEST LAKEVIEW DRIVE
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City | CLINTON
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State | MS
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Zip | 39056-5221
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Country | US
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Telephone | 601-925-2020
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Fax | 601-925-2010
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Authorized Official
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Title or Position | OWNER
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Name | DR. TONYA CANNON STEWART
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Credential | OD
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Telephone | 601-925-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 640
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License Number State | MS
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