Healthcare Provider Details

I. General information

NPI: 1174596472
Provider Name (Legal Business Name): JOHN STEVEN MASON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 N MAIN ST DUPLIN EYE ASSOCIATES PA
KENANSVILLE NC
28349
US

IV. Provider business mailing address

PO BOX 486
KENANSVILLE NC
28349-0486
US

V. Phone/Fax

Practice location:
  • Phone: 910-296-1781
  • Fax: 910-296-1843
Mailing address:
  • Phone: 910-296-1781
  • Fax: 910-296-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1767
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: