Provider Demographics
NPI:1619946027
Name:MASON, KATHERINE SAVAS (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SAVAS
Last Name:MASON
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 1:141 WILDEWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4300
Mailing Address - Country:US
Mailing Address - Phone:803-865-5520
Mailing Address - Fax:803-865-5496
Practice Address - Street 1:141 WILDEWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4300
Practice Address - Country:US
Practice Address - Phone:803-865-5520
Practice Address - Fax:803-865-5496
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1185152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD11850Medicaid
SCD11850Medicaid
SCU87563Medicare UPIN