Provider Demographics
NPI:1255474771
Name:MASUNAGA, DEANNA HIROKO (OD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:HIROKO
Last Name:MASUNAGA
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 1:5701 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5024
Mailing Address - Country:US
Mailing Address - Phone:432-689-3533
Mailing Address - Fax:
Practice Address - Street 1:5701 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5024
Practice Address - Country:US
Practice Address - Phone:432-689-3533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6544T152W00000X
CA11015T152W00000X
LA1326-460T152W00000X
WA3370152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist