Individual
MARY M SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ABOC
Contact information
Practice address
2400 LANCASTER DR NE, SALEM, OR 97305-1221
(503) 370-4851
Mailing address
6200 TREEHOUSE RD, MONMOUTH, OR 97361-9443
(503) 831-3334
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
OR
Other
Enumeration date
09/27/2006
Last updated
07/08/2007
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