Provider Demographics
NPI:1942306998
Name:MASON, JAMES ROBERT (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
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 1:316 W KING ST
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3344
Mailing Address - Country:US
Mailing Address - Phone:704-750-3653
Mailing Address - Fax:704-750-6134
Practice Address - Street 1:316 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3344
Practice Address - Country:US
Practice Address - Phone:704-750-3653
Practice Address - Fax:704-750-6134
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909557Medicaid
NC246265DMedicare ID - Type Unspecified
NC8909557Medicaid