Provider Demographics
NPI:1205939188
Name:MATHIAS, MARY LOUISE (OD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LOUISE
Last Name:MATHIAS
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 1:5 BESSOM ST
Mailing Address - Street 2:BOX #128
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2372
Mailing Address - Country:US
Mailing Address - Phone:617-823-7747
Mailing Address - Fax:
Practice Address - Street 1:641 VETERANS PKWY S
Practice Address - Street 2:THE VISION CENTER
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788-8811
Practice Address - Country:US
Practice Address - Phone:229-890-7418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist