Individual
DR. MASON EDWARD WHITE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O. D.
Contact information
Practice address
407 GEORGE KOSTAS DR, LOGAN, WV 25601-3747
(304) 752-2020
(304) 752-5600
Mailing address
407 GEORGE KOSTAS DR, LOGAN, WV 25601-3747
(304) 752-2020
(304) 752-5600
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0665-IOD
WV
152W00000X
Optometrist
0665OD
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0150540000
—
WV
01
—
0338160001
CIGNA GOVERNMENT SERVICES
WV
Enumeration date
10/31/2005
Last updated
06/09/2020
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