Provider Demographics
NPI:1962841221
Name:LIVINGSTON, MASON GERAL (OD)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:GERAL
Last Name:LIVINGSTON
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 1:54 E 100 N
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2404
Mailing Address - Country:US
Mailing Address - Phone:435-637-2414
Mailing Address - Fax:435-637-8205
Practice Address - Street 1:54 E 100 N
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2404
Practice Address - Country:US
Practice Address - Phone:435-637-2414
Practice Address - Fax:435-637-8205
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8673018-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist