Provider Demographics
NPI:1134113558
Name:DELINO, MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:DELINO
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:PO BOX 2219
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-8219
Mailing Address - Country:US
Mailing Address - Phone:409-794-9590
Mailing Address - Fax:409-794-9590
Practice Address - Street 1:10815 BOWERS DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-8075
Practice Address - Country:US
Practice Address - Phone:409-794-9590
Practice Address - Fax:409-794-9590
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4798T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU43923Medicare UPIN