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General NPI Number Information
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NPI Number | 1073678124
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Entity Type | Organization
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Legal Business Name | MASON & MINCEY OD PA
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 8700 PINEVILLE MATTHEWS RD STE 540
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City | CHARLOTTE
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State | NC
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Zip | 28226-4750
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Country | US
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Telephone | 704-541-8448
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Fax |
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Provider Business Mailing Address
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Address Line | 8700 PINEVILLE MATTHEWS RD STE 540
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City | CHARLOTTE
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State | NC
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Zip | 28226-4750
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Country | US
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Telephone | 704-541-8448
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN SCOTT MINCEY
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Credential | OD
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Telephone | 704-477-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1529
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License Number State | NC
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