Provider Demographics
NPI:1790779015
Name:DEGENAER, PAUL LESLIE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LESLIE
Last Name:DEGENAER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:LESLIE
Other - Last Name:DEGENAER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1902 MERRIMAC TRL
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1233
Mailing Address - Country:US
Mailing Address - Phone:972-547-4200
Mailing Address - Fax:972-547-4202
Practice Address - Street 1:5001 MCKINNEY RANCH PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8601
Practice Address - Country:US
Practice Address - Phone:972-547-4200
Practice Address - Fax:972-547-4202
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2017-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4630T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management