Provider Demographics
NPI:1982688644
Name:STONE, JENNIFER (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STONE
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 1:3616 NORTH FITZHUGH
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204
Mailing Address - Country:US
Mailing Address - Phone:972-722-5397
Mailing Address - Fax:
Practice Address - Street 1:4501 JOE RAMSEY BLVD E
Practice Address - Street 2:STE. 110
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7836
Practice Address - Country:US
Practice Address - Phone:903-454-1886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5279TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102883902Medicaid
TX102883902Medicaid
TX83325EMedicare PIN
TXTXB140326Medicare PIN