Provider Demographics
NPI:1366931594
Name:DONAHUE, ALICIA MARIE (OD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MARIE
Other - Last Name:HANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:939 SALEM ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-1566
Mailing Address - Country:US
Mailing Address - Phone:978-374-8991
Mailing Address - Fax:
Practice Address - Street 1:939 SALEM ST UNIT 7
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:MA
Practice Address - Zip Code:01834-1566
Practice Address - Country:US
Practice Address - Phone:978-374-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5325152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7139846OtherUNITED STATES DEPARTMENT OF JUSTICE