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General NPI Number Information
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NPI Number | 1205205408
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Entity Type | Individual
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Provider Name | MARY CAIRNIE O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 150 S GRAND AVE STE J
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City | GLENDORA
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State | CA
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Zip | 91741-4716
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Country | US
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Telephone | 626-335-2114
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Fax |
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Provider Business Mailing Address
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Address Line | 4245 VIA MARINA # L401
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5280
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Country | US
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Telephone | 330-466-4136
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 56008328
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00662700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9870T
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 33545
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License Number State | CA
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