Provider Demographics
NPI:1033399795
Name:O'HARA, MARY ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:O'HARA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:76 FREDRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-4246
Mailing Address - Country:US
Mailing Address - Phone:856-803-6689
Mailing Address - Fax:
Practice Address - Street 1:37 W ROUTE 130 S
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-2440
Practice Address - Country:US
Practice Address - Phone:609-747-0070
Practice Address - Fax:609-747-0782
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002310152W00000X
NYTUV007439152W00000X
NJ27OM0018300152W00000X
NJ27OA00712000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400021471Medicare PIN