Provider Demographics
NPI:1043407695
Name:DEWART, DEBRA D (OD PA)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:D
Last Name:DEWART
Suffix:
Gender:F
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1819 VZCR 1605
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-5467
Mailing Address - Country:US
Mailing Address - Phone:512-695-0195
Mailing Address - Fax:
Practice Address - Street 1:603 E HIGHWAY 243
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2420
Practice Address - Country:US
Practice Address - Phone:903-567-0577
Practice Address - Fax:903-567-0577
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5237-T152W00000X
TX05237T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist