Provider Demographics
NPI:1245422005
Name:MASON, TIMOTHY (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:MASON
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 1:1395 RESEARCH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2817
Mailing Address - Country:US
Mailing Address - Phone:937-429-2270
Mailing Address - Fax:937-429-5343
Practice Address - Street 1:1395 RESEARCH PARK DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2817
Practice Address - Country:US
Practice Address - Phone:937-429-2270
Practice Address - Fax:937-429-5343
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2791171Medicaid
4219541Medicare PIN