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General NPI Number Information
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NPI Number | 1558700161
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Entity Type | Individual
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Provider Name | MARY ALSUP O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 6101 SARATOGA BLVD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78414-2470
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Country | US
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Telephone | 361-929-5319
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Fax | 844-272-9788
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Provider Business Mailing Address
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Address Line | PO BOX 6362
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City | CORPUS CHRISTI
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State | TX
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Zip | 78466-6362
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Country | US
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Telephone | 361-929-5319
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Fax | 844-272-9788
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8201-T
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License Number State | TX
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