MEDICARE: ANGELA C MARCACCIO O.D.

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	3069	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	11616012	OTHER	TX	CAQH

General Provider Information

NPI Number	:	1235106857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA C MARCACCIO O.D.

Provider Business Mailing Address
First Line	:	9006 CLIFFWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-3507
Country	:	US
Telephone Number	:	713-729-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 HALSEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-4959
Country	:	US
Telephone Number	:	713-453-2972
Fax Number	:	713-450-3609

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/19/2021

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