Provider Demographics
NPI:1801894068
Name:LOUGHREY, MARY ELLEN (OD)
Entity type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:LOUGHREY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N UNION RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5339
Mailing Address - Country:US
Mailing Address - Phone:716-634-4441
Mailing Address - Fax:716-634-3174
Practice Address - Street 1:40 N UNION RD
Practice Address - Street 2:NISWANDER EYE CENTER
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5339
Practice Address - Country:US
Practice Address - Phone:716-634-4441
Practice Address - Fax:716-634-3174
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005781-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01976567Medicaid
NYU66399Medicare UPIN
NY01976567Medicaid