Provider Demographics
NPI:1265501027
Name:MASON, MILTON C (OD)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:C
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 1:498 W HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-1105
Mailing Address - Country:US
Mailing Address - Phone:740-385-4017
Mailing Address - Fax:740-385-7666
Practice Address - Street 1:498 W HUNTER ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1105
Practice Address - Country:US
Practice Address - Phone:740-385-4017
Practice Address - Fax:740-385-7666
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0322976Medicaid
OH0524800001Medicare NSC
OH0322976Medicaid
OH9274701Medicare PIN