Organization Active NPI

Mason Family Vision, P.C.

  • Optometrist
  • Columbia, SC
National Provider Identifier
1679785190
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1186 Issued in SC
Legal business name
MASON FAMILY VISION, P.C.
Practice address
141 Wildewood Park Dr
Columbia, SC 29223-4300
Phone
(803) 865-5520
Fax
(803) 865-5496
NPI assigned
May 4, 2007
Last updated
Feb 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Authorized official

Name
Dr. Katie Mason
Title
Optometrist
Phone
(803) 865-5520

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1186 SC Primary

Addresses

Primary practice location

141 Wildewood Park Dr
Columbia, SC 29223-4300

Mailing address

141 Wildewood Park Dr
Columbia, SC 29223-4300
Phone (803) 865-5520

Other identifiers 1

IdentifierTypeStateIssuer
DA9757MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071220000003 SC Part B Supplier - Clinic/Group Practice 5890885412 Receives reassigned benefits from 2 practitioners
Practice locations: Columbia, SC

National Provider Directory

National Provider Directory

Locations

141 Wildewood Park Dr
Columbia, SC 29223
Phone (803) 865-5520

Practitioners & affiliated clinicians

Practitioners 2

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": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739232000000",
    "number": "1679785190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 WILDEWOOD PARK DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292234300",
            "telephone_number": "803-865-5520",
            "fax_number": "803-865-5496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 WILDEWOOD PARK DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292234300",
            "telephone_number": "803-865-5520",
            "fax_number": "803-865-5496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASON FAMILY VISION, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-07",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "803-865-5520",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9757",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

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

Verify at the official NPI Registry.