DR. MARISSA IZABEL SAN MIGUEL (NPI# 1245751742) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245751742 |
| Entity Type | Individual |
| Full Name | DR. MARISSA IZABEL SAN MIGUEL |
| Credential | OD |
| Practice Address |
5912 Convair Dr Ste 208 Fort Worth TX 76109 |
| Mailing Address |
5841 Recreation Dr Apt 2221 Fort Worth TX 76109-1064 |
| Practice Telephone | 8178807917 |
| Mailing Telephone | 4326642507 |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2018-09-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 9191TG | TX | Eye and Vision Services Providers |
| N | 152W00000X | Optometrist | OPT003031 | GA | Eye and Vision Services Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5505 Peachtree Dunwoody Rd Ste 300, Atlanta, GA 303421713 | 4042570814 | |
| 261 N Harbin Dr, Stephenville, TX 764012814 | 2549682345 |
| Street Address |
5912 CONVAIR DR STE 208 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992277123 | Superior Eye Care PC | Optometrist | 5912 Convair Dr Ste 208, Fort Worth, TX 76109-1269 | 2018-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881156164 | Elizabeth Laborde Dds Pllc | Clinic/Center | 5656 Edwards Ranch Rd, Fort Worth, TX 76109 | 2019-04-04 |
| 1992273965 | Debra Cooper Lantz | Occupational Therapist | 4252 Bryant Irvin Road, Fort Worth, TX 76109 | 2018-11-08 |
| 1417434119 | Dermatology Specialists of Fort Worth Pllc | Dermatology | 6100 Southwest Blvd., Suite 100, Fort Worth, TX 76109 | 2018-07-25 |
| 1417446709 | Eating Recovery Center of Texas, LLC | Clinic/Center | 4200 S. Hulen Street, Suite #436, Ft. Worth, TX 76109 | 2018-05-02 |
| 1174910111 | Parkway Dental Professionals | Preferred Provider Organization | 4200 Bryant Irvin Rd. Ste. 101, Fort Worth, TX 76109 | 2015-04-16 |
| 1831583095 | Deborah K Lehmann, M.d. | Clinic/Center | 6420 Southwest Blvd., #128, Fort Worth, TX 76109 | 2015-03-26 |
| 1184036428 | Ft Worth Ranch Assist, LLC | Neurological Surgery | 3516 Ranch View Terrace, Fort Worth, TX 76109 | 2014-05-21 |
| 1821435538 | Metx LLC | Hearing Instrument Specialist | 4618 Sw Loop 820, Fort Worth, TX 76109 | 2013-06-04 |
| 1356608087 | Virginia Flores | Social Worker | 4208 Ranier Ct, Fort Worth, TX 76109 | 2012-04-19 |
| 1104109552 | Health Imaging Partners, LLC | Physiological Laboratory | 2911 Oak Park Circle, Fort Worth, TX 76109 | 2011-09-22 |
| Find all providers in zip 76109 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841805645 | Mary Kathryn Walters | Optometrist | 655 Taylor Street, Fort Worth, TX 76102-4821 | 2020-09-09 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1275168403 | National Vision Inc | Optometrist | 5609 Sierra Springs Ln, Fort Worth, TX 76123-2183 | 2020-03-09 |
| 1659933125 | Robert Xiang Li | Optometrist | 3524 Highway 114 Ste 300, Fort Worth, TX 76177-2197 | 2019-07-03 |
| 1134781792 | Daniel Max & Marcandrea LLC | Optometrist | 4619 S Hulen St, Suite C, Fort Worth, TX 76132 | 2019-07-03 |
| 1144782889 | Daniel Max & Marcandrea LLC | Optometrist | 8901 N. Freeway Service Rd E, Ste 105, Fort Worth, TX 76177 | 2019-04-02 |
| 1053879569 | Daniel Max & Marcandrea LLC | Optometrist | 501 Alta Mere Dr Ste 1021, Fort Worth, TX 76114-4014 | 2019-03-05 |
| 1083179600 | Joseph Khang Vu | Optometrist | 4800 S Hulen St Ste 147, Fort Worth, TX 76132-1415 | 2019-02-07 |
| 1477030567 | Brandon Ronald Lee | Optometrist | 2644 E Berry St., Fort Worth, TX 76105 | 2018-07-23 |
| 1932685682 | Jennifer Marie Wiernas | Optometrist | 6333 Camp Bowie Blvd Ste 272, Fort Worth, TX 76116-5444 | 2018-07-16 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76109 |
Please comment or provide details below to improve the information on DR. MARISSA IZABEL SAN MIGUEL.
| 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.