Provider Demographics
NPI:1013982198
Name:DE PAZ, CLARISSA J (OD)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:J
Last Name:DE PAZ
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 1:3503 WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2411
Mailing Address - Country:US
Mailing Address - Phone:972-235-3185
Mailing Address - Fax:
Practice Address - Street 1:811 N CENTRAL EXPY
Practice Address - Street 2:SUITE 1000
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8815
Practice Address - Country:US
Practice Address - Phone:972-423-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist