Provider Demographics
NPI:1720176092
Name:ODWYER, MAUREEN C (OD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:C
Last Name:ODWYER
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 1:136E 57TH ST 1502
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2780
Mailing Address - Country:US
Mailing Address - Phone:212-688-0618
Mailing Address - Fax:212-688-0615
Practice Address - Street 1:121 EAST 60TH STREET
Practice Address - Street 2:SUITE 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-327-3415
Practice Address - Fax:212-838-4145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006151152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC236C1OtherMEDICARE ID
NYC236C1OtherMEDICARE ID