Provider Demographics
NPI:1699870527
Name:STOENNER, DEBRA L (OD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
Last Name:STOENNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8445 N GOVERNMENT WAY
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9280
Mailing Address - Country:US
Mailing Address - Phone:208-772-3208
Mailing Address - Fax:208-762-2574
Practice Address - Street 1:8445 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9280
Practice Address - Country:US
Practice Address - Phone:208-772-3208
Practice Address - Fax:208-762-2574
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT44339Medicare UPIN
ID1591317Medicare PIN
ID0563560001Medicare NSC