Provider Demographics
NPI:1205205408
Name:CAIRNIE, MARY (OD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CAIRNIE
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 1:4245 VIA MARINA # L401
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5280
Mailing Address - Country:US
Mailing Address - Phone:330-466-4136
Mailing Address - Fax:
Practice Address - Street 1:150 S GRAND AVE STE J
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4716
Practice Address - Country:US
Practice Address - Phone:626-335-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY56008328152W00000X
NJ27OA00662700152W00000X
TX9870T152W00000X
CA33545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist