Provider Demographics
NPI:1275651952
Name:DECKER, MARYANN KATHLEEN (OPTOMETRIST)
Entity type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:KATHLEEN
Last Name:DECKER
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 ROCKY GLEN RD
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:PA
Mailing Address - Zip Code:18641-9508
Mailing Address - Country:US
Mailing Address - Phone:570-457-0437
Mailing Address - Fax:
Practice Address - Street 1:PEARLE VISION 820 SCRANTON CARBONDALE HIGHWAY
Practice Address - Street 2:EYNON PLAZA
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403
Practice Address - Country:US
Practice Address - Phone:570-876-5050
Practice Address - Fax:570-876-3526
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001325152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA563034Medicare ID - Type UnspecifiedOPTOMETRY