Provider Demographics
NPI:1598750952
Name:FEMRITE, MARY J (OD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:FEMRITE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:308 5TH AVE S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-2343
Mailing Address - Country:US
Mailing Address - Phone:320-685-5400
Mailing Address - Fax:320-685-3506
Practice Address - Street 1:308 5TH AVE S
Practice Address - Street 2:SUITE 110
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-2343
Practice Address - Country:US
Practice Address - Phone:320-685-5400
Practice Address - Fax:320-685-3506
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN2773152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN046677800Medicaid
MN046677800Medicaid
MNU82104Medicare UPIN