MEDICARE: MARK L MASON OD., LLC

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
1	305R00000X	Preferred Provider Organization	4574	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508263120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK L MASON OD., LLC

Provider Business Mailing Address
First Line	:	907 SCHNEIDER ST SE
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-3774
Country	:	US
Telephone Number	:	330-499-1494
Fax Number	:	330-499-3744

Provider Business Practice Location Address
First Line	:	907 SCHNEIDER ST SE
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-3774
Country	:	US
Telephone Number	:	330-499-1494
Fax Number	:	330-499-3744

Authorized Official
Title or Position	:	CLERICAL
Name	:	KIM J WAHL
Credential	:
Telephone Number	:	330-499-1494

Provider Enumeration Date	:	11/25/2014
Last Update Date	:	11/25/2014

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Directions to “MARK L MASON OD., LLC ” Practice Location

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