Provider Demographics
NPI:1306811278
Name:AYER, MARY J (OD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:AYER
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 1:1515 BUSINESS CENTER DR STE 4
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4401
Mailing Address - Country:US
Mailing Address - Phone:904-278-1760
Mailing Address - Fax:904-278-1730
Practice Address - Street 1:1515 BUSINESS CENTER DR STE 4
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4401
Practice Address - Country:US
Practice Address - Phone:904-278-1760
Practice Address - Fax:904-278-1730
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410027569OtherRR MEDICARE
593252808OtherTAX ID
U51167Medicare UPIN
FL1004030001Medicare NSC
FL20507ZMedicare PIN