NPIMap

Organization Active NPI

Jack F Mason MD Professional Corp

  • Optometrist
  • Ukiah, CA
National Provider Identifier
1609811314
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
JACK F MASON MD PROFESSIONAL CORP
Practice address
555 S Dora St
Ukiah, CA 95482-5424
Phone
(707) 462-0581
Fax
(707) 463-0814
NPI assigned
Jun 17, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jack F Mason, MDNPI 1245267087
Title
President
Phone
(707) 462-0581

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary
Ophthalmology Physician 207W00000X NU

Addresses

Primary practice location

555 S Dora St
Ukiah, CA 95482-5424

Mailing address

555 S Dora St
Ukiah, CA 95482-5424
Phone (707) 462-0581

Other identifiers 1

IdentifierTypeStateIssuer
GR0080990MedicaidCA

National Provider Directory

National Provider Directory

Locations

555 S Dora St
Ukiah, CA 95482
Phone (707) 462-0581

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1609811314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 S DORA ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825424",
            "telephone_number": "707-462-0581",
            "fax_number": "707-463-0814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 S DORA ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825424",
            "telephone_number": "707-462-0581",
            "fax_number": "707-463-0814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK F MASON MD PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-462-0581",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0080990",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.