Organization
ADVANCED FAMILY EYECARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WAYNE STONER O.D. (OWNER/ DOCTOR)
(541) 367-2188
Entity
Organization
Contact information
Practice address
2245 LONG ST, SWEET HOME, OR 97386-2845
(541) 367-2188
(541) 367-2189
Mailing address
38661 PALMYRE DR, LEBANON, OR 97355-9284
(541) 401-4649
(541) 367-2189
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2480ATI
OR
332H00000X
Eyewear Supplier
2480ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046719
—
OR
01
—
1160810-1
BUSINESS ID NUMBER
—
01
—
1C 4545640001
DMERC
—
01
—
212671
EYEMED VISION CARE ID NUM
OR
Enumeration date
11/28/2007
Last updated
08/02/2010
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