Provider Demographics
NPI:1497845705
Name:MASON & MINCEY OD PA
Entity Type:Organization
Organization Name:MASON & MINCEY OD PA
Other - Org Name:DOCTORS VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MINCEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-477-1283
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-1219
Mailing Address - Country:US
Mailing Address - Phone:704-739-8028
Mailing Address - Fax:
Practice Address - Street 1:410 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3349
Practice Address - Country:US
Practice Address - Phone:704-739-8028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0117UOtherBLUECROSS BLUESHIELD NC
NC790117UMedicaid
NC0117UOtherBLUECROSS BLUESHIELD NC
NC2471847Medicare PIN