Provider Demographics
NPI:1194610964
Name:WILCOX, MASON (OD)
Entity type:Individual
Prefix:DR
First Name:MASON
Middle Name:
Last Name:WILCOX
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 1:970 N OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-2750
Mailing Address - Country:US
Mailing Address - Phone:417-732-5575
Mailing Address - Fax:
Practice Address - Street 1:970 N OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-2750
Practice Address - Country:US
Practice Address - Phone:417-732-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025018604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist