Healthcare Provider Details

I. General information

NPI: 1790779015
Provider Name (Legal Business Name): PAUL LESLIE DEGENAER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PAUL LESLIE DEGENAER O.D.

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 06/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 MCKINNEY RANCH PKWY SUITE A
MCKINNEY TX
75070-8601
US

IV. Provider business mailing address

1902 MERRIMAC TRL
GARLAND TX
75043-1233
US

V. Phone/Fax

Practice location:
  • Phone: 972-547-4200
  • Fax: 972-547-4202
Mailing address:
  • Phone: 972-547-4200
  • Fax: 972-547-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4630T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: