Provider Demographics
NPI:1881645968
Name:PEARSON, MARY P (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:P
Last Name:PEARSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:PAMELA
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:OPTOMETRIC PROVIDERS OF NEW HAMPSHIRE, P.C.
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:346 S BROADWAY
Practice Address - Street 2:ROUTE 28
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4304
Practice Address - Country:US
Practice Address - Phone:603-898-8560
Practice Address - Fax:603-870-9271
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3184152W00000X
NH0677152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHT95528Medicare UPIN