Provider Demographics
NPI:1659615052
Name:GREGORY J STUCKE
Entity Type:Organization
Organization Name:GREGORY J STUCKE
Other - Org Name:MASON VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-398-3886
Mailing Address - Street 1:218 READING RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1665
Mailing Address - Country:US
Mailing Address - Phone:513-398-3886
Mailing Address - Fax:513-398-9836
Practice Address - Street 1:218 READING RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1665
Practice Address - Country:US
Practice Address - Phone:513-398-3886
Practice Address - Fax:513-398-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5980332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH078360Medicare PIN