Provider Demographics
NPI:1346354230
Name:DEBESA, MANUEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:J
Last Name:DEBESA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:403 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4241
Mailing Address - Country:US
Mailing Address - Phone:817-594-0919
Mailing Address - Fax:817-594-0919
Practice Address - Street 1:4000 E US HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7432
Practice Address - Country:US
Practice Address - Phone:817-573-7153
Practice Address - Fax:817-573-5640
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX3933T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist