1801871223 NPI number — DR. ROSEMARY F DETMER STONE O.D.

Table of content: DR. ROSEMARY F DETMER STONE O.D. (NPI 1801871223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801871223 NPI number — DR. ROSEMARY F DETMER STONE O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DETMER STONE
Provider First Name:
ROSEMARY
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801871223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4655 SW GRIFFITH DR
Provider Second Line Business Mailing Address:
#165
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97005-8728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-646-8592
Provider Business Mailing Address Fax Number:
503-526-3989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4655 SW GRIFFITH DR
Provider Second Line Business Practice Location Address:
#165
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97005-8728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-646-8592
Provider Business Practice Location Address Fax Number:
503-526-3989
Provider Enumeration Date:
12/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152WV0400X , with the licence number:  2568AT , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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