Provider Demographics
NPI:1093741530
Name:TRAIL-O'BRIEN, MAURA LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:MAURA
Middle Name:LEE
Last Name:TRAIL-O'BRIEN
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 1:72 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6207
Mailing Address - Country:US
Mailing Address - Phone:978-374-0386
Mailing Address - Fax:978-372-3631
Practice Address - Street 1:72 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6207
Practice Address - Country:US
Practice Address - Phone:978-374-0386
Practice Address - Fax:978-372-3631
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00515152W00000X
MA4424152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0704997Medicare ID - Type Unspecified