Provider Demographics
NPI:1841278181
Name:HOSEY, MARYANN BONOMO (OD)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:BONOMO
Last Name:HOSEY
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 1:2025 TECHNOLOGY PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9400
Mailing Address - Country:US
Mailing Address - Phone:717-791-2580
Mailing Address - Fax:717-791-2588
Practice Address - Street 1:2025 TECHNOLOGY PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9400
Practice Address - Country:US
Practice Address - Phone:717-791-2580
Practice Address - Fax:717-791-2588
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000332152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA684448QBZMedicare ID - Type Unspecified
PAU20285Medicare UPIN