Healthcare Provider Details

I. General information

NPI: 1609811314
Provider Name (Legal Business Name): JACK F MASON MD PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S DORA ST
UKIAH CA
95482-5424
US

IV. Provider business mailing address

555 S DORA ST
UKIAH CA
95482-5424
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-0581
  • Fax: 707-463-0814
Mailing address:
  • Phone: 707-462-0581
  • Fax: 707-463-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JACK F MASON
Title or Position: PRESIDENT
Credential: MD
Phone: 707-462-0581