Provider Demographics
NPI:1033515325
Name:YOUSSEF, MARYANN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:YOUSSEF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27662 ALISO CREEK RD APT 3202
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3886
Mailing Address - Country:US
Mailing Address - Phone:407-902-8792
Mailing Address - Fax:
Practice Address - Street 1:2223 N WEST SHORE BLVD STE 280
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-7228
Practice Address - Country:US
Practice Address - Phone:407-902-8792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5397152W00000X
390200000X
CA33663152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program