Provider Demographics
NPI:1629569082
Name:WILLIAMS, MASON (OD)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:
Last Name:WILLIAMS
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 1:101 GAELIC DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-2833
Mailing Address - Country:US
Mailing Address - Phone:224-345-8307
Mailing Address - Fax:
Practice Address - Street 1:197 MEDICAL PARK RD STE 101
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8604
Practice Address - Country:US
Practice Address - Phone:704-799-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011282152W00000X
NC2718152W00000X
SC2050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist