Provider Demographics
NPI:1275608978
Name:MARQUEZ, LUIS CARLOS (OD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:CARLOS
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 FREDERICKSBURG RD
Mailing Address - Street 2:STE 107
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-1969
Mailing Address - Country:US
Mailing Address - Phone:210-737-1926
Mailing Address - Fax:210-737-2621
Practice Address - Street 1:901 BEDELL AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4170
Practice Address - Country:US
Practice Address - Phone:830-775-2020
Practice Address - Fax:830-775-4868
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5422TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038371301Medicaid
U70026Medicare UPIN
TX038371301Medicaid