Provider Demographics
NPI:1366746398
Name:MAI, ANNA (OD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MAI
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 1:50 HOLY FAMILY RD
Mailing Address - Street 2:APT # 317
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2846
Mailing Address - Country:US
Mailing Address - Phone:817-881-3962
Mailing Address - Fax:
Practice Address - Street 1:50 HOLYOKE STREET
Practice Address - Street 2:INSIDE LENSCRAFTER, SPC E277
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-532-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4799152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist