MEDICARE: DR. MARYANN YOUSSEF 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	152W00000X	Optometrist	5397	FL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	152W00000X	Optometrist	33663	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033515325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYANN YOUSSEF OD

Provider Business Mailing Address
First Line	:	27662 ALISO CREEK RD APT 3202
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3886
Country	:	US
Telephone Number	:	407-902-8792
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 N WEST SHORE BLVD STE 280
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-7228
Country	:	US
Telephone Number	:	407-902-8792
Fax Number	:

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

Provider Enumeration Date	:	11/13/2014
Last Update Date	:	11/02/2022

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