MEDICARE: DR. MARY MCGEHEE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	799	AZ

General Provider Information

NPI Number	:	1841298338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY MCGEHEE O.D.

Provider Business Mailing Address
First Line	:	3915 E OASIS CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3940 E UNIVERSITY DR
Second Line	:	SUITE 5
City	:	MESA
State	:	AZ
Zip	:	85205-6945
Country	:	US
Telephone Number	:	480-832-0030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/08/2007

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