MARY M SELF (NPI# 1053402511) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053402511 |
| Entity Type | Individual |
| Full Name | MARY M SELF |
| Credential | ABOC |
| Practice Address |
2400 Lancaster Dr Ne Salem OR 97305-1221 |
| Mailing Address |
6200 Treehouse Rd Monmouth OR 97361-9443 |
| Practice Telephone | 5033704851 |
| Mailing Telephone | 5038313334 |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
OR | Eye and Vision Services Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114580826 | Mary Theresa Self | Registered Nurse | 1651 Mott-smith Dr Apt D, Honolulu, HI 96822-2802 | 2019-04-18 |
| 1306882170 | Mary T Self | Internal Medicine | 6400 Dutchmans Pkwy Ste 345, Louisville, KY 40205-3370 | 2006-06-21 |
| Street Address |
2400 LANCASTER DR NE |
| City | SALEM |
| State | OR |
| Zip Code | 97305-1221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801834510 | Kaiser Foundation Health Plan of The Northwest | Pharmacy | 2400 Lancaster Dr Ne, Salem, OR 97305-1221 | 2006-06-03 |
| 1629608070 | Lisa Renea Carr | Dental Assistant | 2400 Lancaster Dr Ne, Salem, OR 97305-1221 | 2020-01-23 |
| 1316594989 | Marisa Hopkins | Social Worker | 2400 Lancaster Dr Ne, Salem, OR 97305-1297 | 2019-08-19 |
| 1346715836 | Stephen Kuang | Pharmacist | 2400 Lancaster Dr Ne, Salem, OR 97305-1297 | 2018-10-10 |
| 1679003313 | Christina Nguyen | Optometrist | 2400 Lancaster Dr Ne, Salem, OR 97305 | 2017-06-15 |
| 1114479128 | Jocelyn Gran | Pharmacist | 2400 Lancaster Dr Ne, Salem, OR 97317 | 2016-10-26 |
| 1518419464 | Kaiser Foundation Health Plan of The Northwest | General Practice | 2400 Lancaster Dr Ne, Salem, OR 97305-1221 | 2016-10-26 |
| 1083166029 | Alison J Green | Nurse Practitioner | 2400 Lancaster Dr Ne, Salem, OR 97305-1221 | 2016-10-25 |
| 1588119515 | Eloisa Chaudhary | Pharmacist | 2400 Lancaster Dr Ne, Salem, OR 97305-1221 | 2016-08-19 |
| 1598117269 | Nathan Howell | Pharmacist | 2400 Lancaster Dr Ne, Salem, OR 97305-1221 | 2016-07-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821639147 | Christine Ann Featherstone | Social Worker | Chemawa Indian Health Center, 3750 Chemawa Road, Salem, OR 97305 | 2019-10-08 |
| 1962996553 | Erin Ann Wakefield | Non-emergency Medical Transport (VAN) | 2425 Fisher Rd Ne, Salem, OR 97305 | 2018-06-18 |
| 1770002271 | Traci L Lee | Case Manager/Care Coordinator | 3876 Beverly Ave Bldg G, Salem, OR 97305 | 2017-09-15 |
| 1952825762 | Matthew Paul Martin | Dentist | 2737 Lancaster Dr Ne Ste 150, Salem, OR 97305 | 2017-08-02 |
| 1043750367 | Sherri King | Physical Therapy Assistant | 4696 Reimann St Ne, Salem, OR 97305 | 2017-03-06 |
| 1760861314 | Amara Lenore Peterson | Counselor | 4347 Sunnyview Rd Ne, Salem, OR 97305 | 2015-05-28 |
| 1720467954 | Heather Rose | Community Health Worker | 4347 Sunnyview Road Ne, Salem, OR 97305 | 2015-05-20 |
| 1588057004 | Carmen Heidecke | Counselor | 4347 Sunnyview Rd. Ne, Salem, OR 97305 | 2015-03-08 |
| 1629476825 | Bryan James Greenaway | Audiologist | 3857 Wolverine St Ne Ste C-16, Salem, OR 97305 | 2014-12-21 |
| 1710300322 | Christopher Ryan | Counselor | 4385 Sunnyview Road Ne, Salem, OR 97305 | 2014-02-03 |
| Find all providers in zip 97305 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316028491 | Wal-mart Stores East, Lp | Technician/Technologist | 1101 W Highway 32, Salem, MO 65560-2368 | 2006-10-17 |
| 1750839072 | Wal-mart Stores East, Lp | Technician/Technologist | 1309 E Hackberry St, Salem, IN 47167-9604 | 2016-09-15 |
| 1134594682 | Wal-mart Stores East, Lp | Technician/Technologist | 450 Highland Ave, Salem, MA 01970-1765 | 2015-12-09 |
| 1013200575 | Heidi Elise Martin | Technician/Technologist | 224 N Broadway, Suite B1, Salem, NH 03079-2145 | 2011-05-17 |
| 1215232384 | Judith Catherine Delvalle-webb | Technician/Technologist | 224 N Broadway, Rt 28 Bldg E1, Salem, NH 03079-2145 | 2011-01-20 |
| 1265742084 | Matthew K Tucker | Technician/Technologist | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2010-10-14 |
| 1700026663 | Peouvisak Pen | Technician/Technologist | 151 Main St, Suite #10, Salem, NH 03079-3109 | 2009-03-04 |
| 1912059882 | Banville Optical Inc. | Technician/Technologist | 88 Lafayette St, Salem, MA 01970-3625 | 2007-01-18 |
| 1700967528 | Wal-mart Stores, Inc | Technician/Technologist | 1870 W Main St, Salem, IL 62881-5838 | 2006-10-18 |
| 1598846354 | Wal-mart Stores, Inc | Technician/Technologist | 1940 Turner Rd Se, Salem, OR 97302-2003 | 2006-10-18 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.