Provider Demographics
NPI:1598821621
Name:MASON, GERARD STANLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:STANLEY
Last Name:MASON
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 1:60 WOOD POND RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3702
Mailing Address - Country:US
Mailing Address - Phone:860-633-6236
Mailing Address - Fax:
Practice Address - Street 1:60 WOOD POND RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3702
Practice Address - Country:US
Practice Address - Phone:860-633-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist