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NPI Code Detail

MEDICARE: DR. MARY A MASTERS O.D.

MEDICARE: DR. MARY A MASTERS O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1086NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10953COTHERNCBLUE CROSS & BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487626263
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY A MASTERS O.D.
Provider Business Mailing Address
First Line : PO BOX 804
Second Line :
City : LUMBERTON
State : NC
Zip : 28359-0804
Country : US
Telephone Number : 910-618-9947
Fax Number :
Provider Business Practice Location Address
First Line : 3701 S MAIN ST
Second Line :
City : HOPE MILLS
State : NC
Zip : 28348-1958
Country : US
Telephone Number : 910-423-0700
Fax Number : 910-423-0974
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 05/24/2019

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