Provider Demographics
NPI:1487604252
Name:STOLL, DAVID RAYMOND (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAYMOND
Last Name:STOLL
Suffix:
Gender:M
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:G3541 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1235
Mailing Address - Country:US
Mailing Address - Phone:810-732-8610
Mailing Address - Fax:810-732-6831
Practice Address - Street 1:G3541 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1235
Practice Address - Country:US
Practice Address - Phone:810-732-8610
Practice Address - Fax:810-732-6831
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901003650OtherEYECARE ALLIANCE
MI31986OtherEYEMED COLE
MI4901003650OtherLICENSE DR STOLL
MI27671OtherSPECTERA
MI230370OtherNVA-HERITAGE
MI7333067OtherAETNA
MI1010350OtherMCLAREN MEDICAID
MI7333067OtherAETNA
MI4901003650OtherLICENSE DR STOLL
MI0B56200Medicare ID - Type Unspecified