Provider Demographics
NPI:1083697353
Name:MARIA, AILEEN (OD)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:MARIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MERRIMACK ST
Mailing Address - Street 2:BLDG 9
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1740
Mailing Address - Country:US
Mailing Address - Phone:978-688-6182
Mailing Address - Fax:978-689-0731
Practice Address - Street 1:360 MERRIMACK ST
Practice Address - Street 2:BLDG 9
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1740
Practice Address - Country:US
Practice Address - Phone:978-688-6182
Practice Address - Fax:978-689-0731
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4319152W00000X
NH0743152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0337081Medicaid
NH30352264Medicaid
NHRE6978Medicare Oscar/Certification
MAW17443Medicare ID - Type Unspecified
U91719Medicare UPIN