Provider Demographics
NPI:1093907784
Name:MASON, STEPHEN
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 TAMIAMI TRL
Mailing Address - Street 2:SUITE G
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2152
Mailing Address - Country:US
Mailing Address - Phone:941-625-6602
Mailing Address - Fax:941-625-0021
Practice Address - Street 1:4265 TAMIAMI TRL
Practice Address - Street 2:SUITE G
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2152
Practice Address - Country:US
Practice Address - Phone:941-625-6602
Practice Address - Fax:941-625-0021
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE702156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician