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General NPI Number Information
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NPI Number | 1679132278
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Entity Type | Individual
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Provider Name | MELISSA MARIE POPPENHUSEN OD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 06/07/2019
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Provider Practice Location Address
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Address Line | 3801 N CAPITAL OF TEXAS HWY STE C100
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City | AUSTIN
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State | TX
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Zip | 78746-1466
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Country | US
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Telephone | 512-651-5186
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Fax |
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Provider Business Mailing Address
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Address Line | 14403 CYPRESS RIDGE DR
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City | CYPRESS
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State | TX
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Zip | 77429-6308
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Country | US
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Telephone | 281-731-3163
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Fax |
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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 | 9666T
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License Number State | TX
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