Individual
MARY A DESANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
150 BROOKLYN ST, CARBONDALE, PA 18407
(570) 282-7188
(570) 282-4402
Mailing address
200 MIFFLIN AVE, SCRANTON, PA 18503
(570) 342-3145
(570) 344-1309
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000527
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001163415
—
PA
01
—
073339
FIRST PRIORITY HEALTH
—
01
—
20969
GEISINGER HEALTH PLAN
—
01
—
410024727
RAILROAD MEDICARE
—
01
—
506554
AETNA
—
01
—
DE567588
HIGH MARK BLUE SHIELD
—
Enumeration date
08/13/2006
Last updated
12/01/2022
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