Provider Demographics
NPI:1235106857
Name:MARCACCIO, ANGELA C (OD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:MARCACCIO
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 1:9006 CLIFFWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-3507
Mailing Address - Country:US
Mailing Address - Phone:713-729-2030
Mailing Address - Fax:
Practice Address - Street 1:1051 HALSEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4959
Practice Address - Country:US
Practice Address - Phone:713-453-2972
Practice Address - Fax:713-450-3609
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1548216-01Medicaid
TX1122897-08Medicaid
TX11616012OtherCAQH
TX81391EMedicare PIN
TX11616012OtherCAQH
TX1548216-01Medicaid