NPIMap

Organization Active NPI

Mary Reed Dacanal OD Inc.

  • Optometrist
  • Ridgway, PA
National Provider Identifier
1699060335
Registry record updated Jun 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG000721 Issued in PA
Legal business name
MARY REED DACANAL OD INC.
Practice address
20 N Broad St
Ridgway, PA 15853-8018
Phone
(814) 772-0674
NPI assigned
Jun 10, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Dacanal, OWNER
Title
Optometrist
Phone
(814) 772-0674

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X OEG000721 PA Primary

Addresses

Primary practice location

20 N Broad St
Ridgway, PA 15853-8018

Mailing address

20 N Broad St
Ridgway, PA 15853-8018
Phone (814) 772-0674

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307664000000",
    "number": "1699060335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 N BROAD ST",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "158538018",
            "telephone_number": "814-772-0674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 N BROAD ST",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "158538018",
            "telephone_number": "814-772-0674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY REED DACANAL OD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-10",
        "last_updated": "2011-06-10",
        "status": "A",
        "authorized_official_last_name": "DACANAL",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "814-772-0674",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgway, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.