Provider Demographics
NPI:1588277735
Name:MASSENGILL, MARY ELIZABETH RAYNOR (OD)
Entity type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:RAYNOR
Last Name:MASSENGILL
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 1:113 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-1343
Mailing Address - Country:US
Mailing Address - Phone:919-894-7579
Mailing Address - Fax:919-894-4674
Practice Address - Street 1:113 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-1343
Practice Address - Country:US
Practice Address - Phone:919-894-7579
Practice Address - Fax:919-894-4674
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2622152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist