Provider Demographics
NPI:1508072125
Name:COSGROVE, MARY JANE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY JANE
Middle Name:
Last Name:COSGROVE
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 1:407 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FACTORYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18419-9794
Mailing Address - Country:US
Mailing Address - Phone:570-945-5372
Mailing Address - Fax:
Practice Address - Street 1:LENSCRAFTERS RT 6
Practice Address - Street 2:VIEWMONT MALL
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508
Practice Address - Country:US
Practice Address - Phone:570-341-7109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG 000793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist