Provider Demographics
NPI:1952454662
Name:BEGENY-MAHAN, MARLOS DARLENE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARLOS
Middle Name:DARLENE
Last Name:BEGENY-MAHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 E HAYMARKET WAY
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4671
Mailing Address - Country:US
Mailing Address - Phone:330-342-9846
Mailing Address - Fax:
Practice Address - Street 1:7969 W RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5516
Practice Address - Country:US
Practice Address - Phone:440-884-3090
Practice Address - Fax:440-884-1046
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4002152W00000X
PAOE006855P152W00000X
CO1393152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH20-3287006OtherTAX ID