Healthcare Provider Details

I. General information

NPI: 1306929187
Provider Name (Legal Business Name): GERALD CHASKELSON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NEW ATHOL RD
ORANGE MA
01364-9603
US

IV. Provider business mailing address

236 NICHOLAS DRIVE
LANCASTER MA
01523
US

V. Phone/Fax

Practice location:
  • Phone: 978-249-6308
  • Fax:
Mailing address:
  • Phone: 978-368-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2213
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: