Provider Demographics
NPI:1982938163
Name:JOY, MARY (OPTICIAN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:JOY
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 1:14 ELM ST
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2318
Mailing Address - Country:US
Mailing Address - Phone:518-235-5959
Mailing Address - Fax:
Practice Address - Street 1:42 3RD ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3906
Practice Address - Country:US
Practice Address - Phone:518-274-8181
Practice Address - Fax:518-272-8164
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008803-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician