Provider Demographics
NPI:1760990642
Name:MARY H ESPY OD PC
Entity Type:Organization
Organization Name:MARY H ESPY OD PC
Other - Org Name:DELTAVISION OPTICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:ESPY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-814-5527
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:810-732-6831
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:810-732-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-13
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4445165Medicaid