Healthcare Provider Details

I. General information

NPI: 1225114812
Provider Name (Legal Business Name): JOY SIMPSON MASON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MEIJER WAY
LEXINGTON KY
40503-3340
US

IV. Provider business mailing address

340 MEIJER WAY
LEXINGTON KY
40503-3340
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-0055
  • Fax: 859-277-4490
Mailing address:
  • Phone: 859-278-0055
  • Fax: 859-277-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1575DT
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1575DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: