Provider Demographics
NPI:1760767461
Name:SAMUELS, MARIANNA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARIANNA
Other - Middle Name:
Other - Last Name:MKRTCHYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:477 N EL CAMINO REAL STE C202
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1332
Mailing Address - Country:US
Mailing Address - Phone:760-631-3500
Mailing Address - Fax:
Practice Address - Street 1:477 N EL CAMINO REAL STE C202
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1332
Practice Address - Country:US
Practice Address - Phone:760-631-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14196TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist