Provider Demographics
NPI:1538130703
Name:ESPY, MARY H (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:H
Last Name:ESPY
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:G3541 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1235
Mailing Address - Country:US
Mailing Address - Phone:810-732-8610
Mailing Address - Fax:
Practice Address - Street 1:G3541 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1235
Practice Address - Country:US
Practice Address - Phone:810-732-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003627152W00000X
MION54860152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4445165Medicaid
11839337OtherCAQH
MIP60754OtherBLUE CARE NETWORK
MIP60754OtherBLUE CARE NETWORK
MIP60754OtherBLUE CARE NETWORK
MIU58235Medicare UPIN