Provider Demographics
NPI:1013194133
Name:NYITRAY, MARY LOU (LDO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:NYITRAY
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3022
Mailing Address - Country:US
Mailing Address - Phone:419-535-7837
Mailing Address - Fax:419-535-7838
Practice Address - Street 1:2934 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3022
Practice Address - Country:US
Practice Address - Phone:419-535-7837
Practice Address - Fax:419-535-7838
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH74SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0170710Medicaid