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General NPI Number Information
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NPI Number | 1023972916
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Entity Type | Individual
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Provider Name | MAUREEN MICHELE MATHER LDO
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Gender | Female
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 201 SILVER ST
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City | PERU
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State | NY
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Zip | 12972-3529
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Country | US
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Telephone | 518-566-8096
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Fax | 518-566-0085
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Provider Business Mailing Address
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Address Line | 201 SILVER ST
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City | PERU
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State | NY
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Zip | 12972-3529
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Country | US
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Telephone | 518-566-8096
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Fax | 518-566-0085
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 009713
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License Number State | NY
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