Provider Demographics
NPI:1366055105
Name:STINSON, MARQUAVIA SHAMIA (OD)
Entity type:Individual
Prefix:
First Name:MARQUAVIA
Middle Name:SHAMIA
Last Name:STINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHA'MIA
Other - Middle Name:
Other - Last Name:STINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:448 SOFT WINDS VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-7642
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9733 NORTHLAKE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0109
Practice Address - Country:US
Practice Address - Phone:704-921-3744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist