Physician Compare National (NPI:1003802422)

HEALTHCARE PROVIDER: MARY LEE PEMBERTON O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1003802422
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9335218858
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080522000634
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PEMBERTON
	Individual professional last name
Provider First Name	MARY
	Individual professional first name
Provider Middle Name	LEE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	SOUTHERN COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	1998
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2522 JEFFERSON HWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 106
	Group Practice or individual's line 2 address
City	WAYNESBORO
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	229808503
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y