Provider Demographics
NPI:1497782619
Name:SPENCER, MARY ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:TILLOTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-5420
Mailing Address - Country:US
Mailing Address - Phone:401-741-7569
Mailing Address - Fax:
Practice Address - Street 1:231 NEW BOSTON RD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5563
Practice Address - Country:US
Practice Address - Phone:508-673-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
050369447OtherVISION SERVICE PLAN
5983559OtherCIGNA
29196OtherNEIGHBORHOOD HEALTH
RI7050217Medicaid
7431490OtherAETNA NONHMO
3369747OtherAETNA HMO
411355OtherBLUE CHIP
RI2201173OtherUNITED HEALTHCARE
RI324OtherBLUE CROSS BLUE SHIELD
R001038OtherTRICARE GROUP
29196OtherNEIGHBORHOOD HEALTH
7431490OtherAETNA NONHMO