MEDICARE: DR. TIMOTHY J. MASON 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
1	152W00000X	Optometrist	1659	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	0191040001	OTHER	KS	MEDICARE NSC
9	P00467868	OTHER	KS	RR MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7304	OTHER	KS	PREFERRED HEALTHE SYSTEMS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	201552	OTHER	KS	HEALTH PARTNERS OF KS
4	651172	OTHER	KS	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	462314	OTHER	KS	HEALTHWAVE
8	468501	OTHER	KS	CHILDREN'S MERCY/FHP

General Provider Information

NPI Number	:	1992703573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY J. MASON O.D.

Provider Business Mailing Address
First Line	:	9390 E CENTRAL AVE
Second Line	:	STE 101
City	:	WICHITA
State	:	KS
Zip	:	67206-2555
Country	:	US
Telephone Number	:	316-636-2080
Fax Number	:	316-636-2965

Provider Business Practice Location Address
First Line	:	9390 E CENTRAL AVE
Second Line	:	STE 101
City	:	WICHITA
State	:	KS
Zip	:	67206-2555
Country	:	US
Telephone Number	:	316-636-2080
Fax Number	:	316-636-2965

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	10/11/2012

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Directions to “ DR. TIMOTHY J. MASON O.D.” Practice Location

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