Provider Demographics
NPI:1861450413
Name:ANAGNOST, MARY E (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:ANAGNOST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:MENCHACA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1009 E LA HABRA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631
Mailing Address - Country:US
Mailing Address - Phone:562-697-1600
Mailing Address - Fax:562-697-1600
Practice Address - Street 1:1009 E LA HABRA BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631
Practice Address - Country:US
Practice Address - Phone:562-697-1600
Practice Address - Fax:562-697-1600
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9445T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P9445Medicare ID - Type Unspecified