Provider Demographics
NPI:1245751742
Name:SOONG, MARISSA IZABEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:IZABEL
Last Name:SOONG
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 1:11305 CULZEAN CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-2400
Mailing Address - Country:US
Mailing Address - Phone:432-664-2507
Mailing Address - Fax:
Practice Address - Street 1:9900 W PARMER LN STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4970
Practice Address - Country:US
Practice Address - Phone:512-339-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003031152W00000X
TX9191TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist