Provider Demographics
NPI:1457093155
Name:MASSENGALE, KARA JOY
Entity Type:Individual
Prefix:MS
First Name:KARA
Middle Name:JOY
Last Name:MASSENGALE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KARA
Other - Middle Name:JOY
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N. TRAVIS ST STE C
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090
Mailing Address - Country:US
Mailing Address - Phone:903-819-8653
Mailing Address - Fax:903-829-3437
Practice Address - Street 1:100 N. TRAVIS ST STE C
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090
Practice Address - Country:US
Practice Address - Phone:903-819-8653
Practice Address - Fax:903-829-3437
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician