Provider Demographics
NPI:1487626263
Name:MASTERS, MARY A (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:MASTERS
Suffix:
Gender:F
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:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-0804
Mailing Address - Country:US
Mailing Address - Phone:910-618-9947
Mailing Address - Fax:
Practice Address - Street 1:3701 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1958
Practice Address - Country:US
Practice Address - Phone:910-423-0700
Practice Address - Fax:910-423-0974
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0953COtherBLUE CROSS & BLUE SHIELD
NC890953CMedicaid
NC0953COtherBLUE CROSS & BLUE SHIELD
NC246437EMedicare PIN