Provider Demographics
NPI:1750345435
Name:FORAN, MARILYN RENEE (OD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:RENEE
Last Name:FORAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:RENEE
Other - Last Name:BIELINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:207 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3204
Mailing Address - Country:US
Mailing Address - Phone:607-734-2984
Mailing Address - Fax:607-398-3411
Practice Address - Street 1:1805 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5531
Practice Address - Country:US
Practice Address - Phone:607-748-3434
Practice Address - Fax:607-398-3408
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0053061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00392645OtherRR MEDICARE
P00392645OtherRR MEDICARE