MEDICARE: DR. JAMES JOSEPH DEMARCO JR. OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	9300TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9300TG	OTHER	TX	TEXAS LIC NUMBER

General Provider Information

NPI Number	:	1043739568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES JOSEPH DEMARCO JR. OD

Provider Business Mailing Address
First Line	:	299 KINGSPOINT DR APT 103
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6510
Country	:	US
Telephone Number	:	469-450-0438
Fax Number	:

Provider Business Practice Location Address
First Line	:	7555 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-3505
Country	:	US
Telephone Number	:	469-450-0438
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2017
Last Update Date	:	09/15/2017

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