Provider Demographics
NPI:1639264526
Name:HAGEMAN, GERALD FRANCIS (OD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:FRANCIS
Last Name:HAGEMAN
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 1:719 NEW SHERBORN RD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-9584
Mailing Address - Country:US
Mailing Address - Phone:978-249-3401
Mailing Address - Fax:
Practice Address - Street 1:352 PALMER RD
Practice Address - Street 2:
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-9740
Practice Address - Country:US
Practice Address - Phone:413-967-7561
Practice Address - Fax:413-967-7631
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist