Provider Demographics
NPI:1972586022
Name:CLEARY, KATHLEEN MONICA (OD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MONICA
Last Name:CLEARY
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 1:570 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:EAST WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-1033
Mailing Address - Country:US
Mailing Address - Phone:781-331-9664
Mailing Address - Fax:
Practice Address - Street 1:470 SOUTHERN ARTERY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4614
Practice Address - Country:US
Practice Address - Phone:617-773-8050
Practice Address - Fax:617-770-9453
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0392154Medicaid
MAW15820Medicare ID - Type Unspecified
MAU11829Medicare UPIN