Individual
DR. MARY C LACK
Active
Individual
DR. MARY C LACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4364
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000141886
ANTHEM
OH
01
—
0266520001
ADMINISTAR
OH
05
—
0892155
—
OH
01
—
2200676
UNITED HEALTH CARE
OH
01
—
341904624
TRICARE
OH
01
—
341904624ML
SUMMA
OH
01
—
410041657
RAILROAD MEDICARE
OH
01
—
54450
QUAL CHOICE
OH
01
—
5521525
AETNA
OH
Enumeration date
09/27/2005
Last updated
04/08/2011
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up