Provider Demographics
NPI:1316082944
Name:STONE, TU LAM (OD)
Entity type:Individual
Prefix:
First Name:TU
Middle Name:LAM
Last Name:STONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TU
Other - Middle Name:LAM
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:365 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2311
Mailing Address - Country:US
Mailing Address - Phone:662-563-9880
Mailing Address - Fax:
Practice Address - Street 1:365 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2311
Practice Address - Country:US
Practice Address - Phone:662-563-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS666152W00000X
MS773152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07086863Medicaid
MS07086863Medicaid
MSU96960Medicare UPIN
MS410000295Medicare PIN
MS0410048869Medicare NSC