Provider Demographics
NPI:1831129329
Name:HOWARD, MARY LEANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LEANNE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13487 CAMINO CANADA
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021
Mailing Address - Country:US
Mailing Address - Phone:619-390-4594
Mailing Address - Fax:619-390-4759
Practice Address - Street 1:13487 CAMINO CANADA
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-8811
Practice Address - Country:US
Practice Address - Phone:619-390-4594
Practice Address - Fax:619-390-4759
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT00009730TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN