MEDICARE: DR. MASON WILLIAMS OD

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	152W00000X	Optometrist	046.011282	IL
2	152W00000X	Optometrist	2718	NC

General Provider Information

NPI Number	:	1629569082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASON WILLIAMS OD

Provider Business Mailing Address
First Line	:	101 GAELIC DR
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28625-2833
Country	:	US
Telephone Number	:	224-345-8307
Fax Number	:

Provider Business Practice Location Address
First Line	:	197 MEDICAL PARK RD STE 101
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-8604
Country	:	US
Telephone Number	:	704-799-2233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	05/31/2023

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