Provider Demographics
NPI:1871266551
Name:MARY JANE COSGROVE, P.C.
Entity type:Organization
Organization Name:MARY JANE COSGROVE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:COSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-341-7109
Mailing Address - Street 1:LENS CRAFTERS RT # 6
Mailing Address - Street 2:VIEWMONT MALL
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508
Mailing Address - Country:US
Mailing Address - Phone:570-341-7109
Mailing Address - Fax:570-341-6774
Practice Address - Street 1:LENS CRAFTERS RT # 6
Practice Address - Street 2:VIEWMONT MALL
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508
Practice Address - Country:US
Practice Address - Phone:570-341-7109
Practice Address - Fax:570-341-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty