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General NPI Number Information
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NPI Number | 1780742270
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Entity Type | Organization
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Legal Business Name | BENJAMIN D STONE INC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 340 3RD ST
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City | INTERNATIONAL FALLS
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State | MN
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Zip | 56649
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Country | US
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Telephone | 218-283-4788
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Fax |
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Provider Business Mailing Address
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Address Line | 340 3RD ST
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City | INTERNATIONAL FALLS
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State | MN
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Zip | 56649
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Country | US
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Telephone | 218-283-4788
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Fax |
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Authorized Official
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Title or Position | BOOKKEEPER OWNER
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Name | VICKI LYNN STONE
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Credential |
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Telephone | 218-283-4788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1583
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1583
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License Number State | MN
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