Provider Demographics
NPI:1427406123
Name:STINSON, GERALD W JR (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:W
Last Name:STINSON
Suffix:JR
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 1:210 COURT SQ
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-3628
Mailing Address - Country:US
Mailing Address - Phone:662-834-2982
Mailing Address - Fax:
Practice Address - Street 1:210 COURT SQ
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3628
Practice Address - Country:US
Practice Address - Phone:662-834-2982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3302152W00000X
MS943152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist