Provider Demographics
NPI:1366201212
Name:O'NEIL, MARY (LDO)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 GENESEE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2654
Mailing Address - Country:US
Mailing Address - Phone:315-361-1037
Mailing Address - Fax:315-361-1933
Practice Address - Street 1:2024 GENESEE ST STE 1
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2654
Practice Address - Country:US
Practice Address - Phone:315-361-1037
Practice Address - Fax:315-361-1933
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty