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General NPI Number Information
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NPI Number | 1609811314
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Entity Type | Organization
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Legal Business Name | JACK F MASON MD PROFESSIONAL CORP
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 555 S DORA ST
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City | UKIAH
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State | CA
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Zip | 95482-5424
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Country | US
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Telephone | 707-462-0581
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Fax | 707-463-0814
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Provider Business Mailing Address
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Address Line | 555 S DORA ST
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City | UKIAH
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State | CA
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Zip | 95482-5424
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Country | US
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Telephone | 707-462-0581
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Fax | 707-463-0814
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK F MASON
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Credential | MD
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Telephone | 707-462-0581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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