Individual
MRS. STEPHANIE ANN MASTERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPT
Contact information
Practice address
104 KASSON RD STE C, CAMILLUS, NY 13031-2266
(315) 487-0327
(315) 487-4425
Mailing address
104 KASSON RD STE C, CAMILLUS, NY 13031-2266
(315) 487-0237
(315) 487-4425
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
007627-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02186423
—
NY
Enumeration date
10/12/2006
Last updated
12/28/2020
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