Provider Demographics
NPI:1336708734
Name:DY, MARY E (OD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:DY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:TROYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:82 SAINT STEPHEN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-4302
Mailing Address - Country:US
Mailing Address - Phone:812-774-2830
Mailing Address - Fax:
Practice Address - Street 1:1340 BOYLSTON ST # 6F
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4302
Practice Address - Country:US
Practice Address - Phone:857-313-6594
Practice Address - Fax:617-236-4262
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5351152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist