Provider Demographics
NPI:1891779559
Name:O'HARA, MARY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:O'HARA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE 2400, OPHTHALMOLOGY & VISION SCIENCE
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-1321
Mailing Address - Fax:916-734-6992
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 2400, OPHTHALMOLOGY & VISION SCIENCE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-1321
Practice Address - Fax:916-734-6992
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-12-27
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Provider Licenses
StateLicense IDTaxonomies
CAG87185207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR002104IMedicaid
CA00G871850Medicare PIN
CAGR002104IMedicaid