Provider Demographics
NPI:1710940564
Name:POWELL, DEANNA J (OD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:J
Last Name:POWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:12934 GRANDSTAND WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-7280
Mailing Address - Country:US
Mailing Address - Phone:904-584-2230
Mailing Address - Fax:913-254-9613
Practice Address - Street 1:1228 US 377
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-7280
Practice Address - Country:US
Practice Address - Phone:904-584-2230
Practice Address - Fax:913-254-9613
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8320T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS203384798OtherFREEDOM NETWORK
KS20338479866220A002OtherTRICARE
KS31795041OtherBC/BS OF KC
KS7038483OtherAETNA
KS20-3384798OtherUHC