Provider Demographics
NPI:1285105700
Name:RAWLING, MARY (OPTICIAN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:RAWLING
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 LONDON ROAD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12185
Mailing Address - Country:US
Mailing Address - Phone:518-782-0672
Mailing Address - Fax:518-785-0503
Practice Address - Street 1:800 LONDON ROAD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12185
Practice Address - Country:US
Practice Address - Phone:518-782-0672
Practice Address - Fax:518-785-0503
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008183-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician