Provider Demographics
NPI:1952680209
Name:ZAPPALA, MARY-ANN (OD)
Entity Type:Individual
Prefix:
First Name:MARY-ANN
Middle Name:
Last Name:ZAPPALA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARY-ANN
Other - Middle Name:
Other - Last Name:ECMECIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:11 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7904
Mailing Address - Country:US
Mailing Address - Phone:617-734-7171
Mailing Address - Fax:857-337-1074
Practice Address - Street 1:11 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7904
Practice Address - Country:US
Practice Address - Phone:617-734-7171
Practice Address - Fax:573-371-0748
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist