Individual
DR. MARY SUSAN LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
3875 US HIGHWAY 301 S, RIVERVIEW, FL 33578
(813) 246-3186
(813) 542-2246
Mailing address
2306 GOLF MANOR BLVD, VALRICO, FL 33596-7852
(813) 716-5150
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 3537
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6205704 00
—
FL
Enumeration date
09/27/2006
Last updated
05/22/2018
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