Provider Demographics
NPI:1598847923
Name:HUTTON, MARY KATHLEEN (OD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:HUTTON
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 1:304 N ST
Mailing Address - Street 2:STE 1
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21922-0446
Mailing Address - Country:US
Mailing Address - Phone:410-398-2112
Mailing Address - Fax:410-620-0047
Practice Address - Street 1:304 N ST
Practice Address - Street 2:STE 1
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21922-0446
Practice Address - Country:US
Practice Address - Phone:410-398-2112
Practice Address - Fax:410-620-0047
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0819152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R8920001OtherFEDERAL EMPLOYEE PROG
T87925Medicare UPIN
R8920001OtherFEDERAL EMPLOYEE PROG