Provider Demographics
NPI:1497813646
Name:ZANELLA, DEBORAH (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:ZANELLA
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 1:2111 KIRKWOOD BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1461
Mailing Address - Country:US
Mailing Address - Phone:817-416-2010
Mailing Address - Fax:817-416-2013
Practice Address - Street 1:1251 EAST SOUTHLAKE BOULEVARD
Practice Address - Street 2:SUITE 331
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:817-310-0289
Practice Address - Fax:817-310-0684
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6867T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4741Medicare PIN
U95412Medicare UPIN