Provider Demographics
NPI:1184285801
Name:STETSON, GRAHAM (OD, MS)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:
Last Name:STETSON
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3546
Mailing Address - Country:US
Mailing Address - Phone:781-352-4849
Mailing Address - Fax:781-634-8352
Practice Address - Street 1:696 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3546
Practice Address - Country:US
Practice Address - Phone:781-352-4849
Practice Address - Fax:781-634-8352
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist