Provider Demographics
NPI:1134166465
Name:MAHAFFEY, DONNA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:KISH-MAHAFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5550 W CENTRAL AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1517
Mailing Address - Country:US
Mailing Address - Phone:419-539-6989
Mailing Address - Fax:419-539-6988
Practice Address - Street 1:5550 W CENTRAL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1517
Practice Address - Country:US
Practice Address - Phone:419-539-6989
Practice Address - Fax:419-539-6988
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4566/T1309152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03188OtherPARAMOUNT HEALTH INSURANC
OHOH4566OtherEYEMED HEALTH INSURANCE
OHMA0778354Medicare PIN
OH03188OtherPARAMOUNT HEALTH INSURANC