Provider Demographics
NPI:1770622045
Name:MCMAINS, MARY (OD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCMAINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3323 PINE NEEDLE CIR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1147
Mailing Address - Country:US
Mailing Address - Phone:512-900-0322
Mailing Address - Fax:512-237-7357
Practice Address - Street 1:535 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1504
Practice Address - Country:US
Practice Address - Phone:775-323-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA119076152W00000X
AK197606152W00000X
AZOPT-002560152W00000X
TX7041TG152W00000X, 152WS0006X, 152WV0400X, 152WX0102X, 152WX0102X
MN3858152W00000X
NV1055152W00000X
TX7041T152WX0102X, 152WV0400X, 152WX0102X
CA11525T152WX0102X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA119076OtherIOWA BOARD OF OPTOMETRY
NV1055OtherNV BOARD OF OPTOMETRY LICENSE
AK197606OtherALASKA BOARD OF OPTOMETRY
AZOPT-002560OtherARIZONA BOARD OF OPTOMETRY
MN3858OtherMINNESOTA BOARD OF OPTOMETRY
TX7041TGOtherTEXAS BOARD OF OPTOMETRY