Provider Demographics
NPI:1073515284
Name:NASON, MICHAEL STUART (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STUART
Last Name:NASON
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 1:4415 SIDEWINDER TRL
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-3250
Mailing Address - Country:US
Mailing Address - Phone:561-951-7285
Mailing Address - Fax:
Practice Address - Street 1:1075 OAKLEAF PLANTATION PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-3625
Practice Address - Country:US
Practice Address - Phone:904-449-7720
Practice Address - Fax:904-385-2077
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002692152WC0802X
FLOPC2692152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620019200Medicaid
FL620019200Medicaid
FLFL2692OtherEYEMED
FLU51433Medicare UPIN