Provider Demographics
NPI:1417519117
Name:MCGONIGLE, MARANDA KATHRYN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARANDA
Middle Name:KATHRYN
Last Name:MCGONIGLE
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 1:361 COUNTY ROAD 3699
Mailing Address - Street 2:
Mailing Address - City:SPRINGTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:76082-3839
Mailing Address - Country:US
Mailing Address - Phone:817-629-6454
Mailing Address - Fax:
Practice Address - Street 1:3916 KEMP BLVD STE K
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2119
Practice Address - Country:US
Practice Address - Phone:940-285-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist