Provider Demographics
NPI:1427012459
Name:MCCARTHY, MARY T (OD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:6157 US ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084-3404
Mailing Address - Country:US
Mailing Address - Phone:315-677-3193
Mailing Address - Fax:315-677-3196
Practice Address - Street 1:819 S SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3536
Practice Address - Country:US
Practice Address - Phone:315-476-7921
Practice Address - Fax:315-475-1448
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005393152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU42081Medicare UPIN