Provider Demographics
NPI:1255613238
Name:DEMAGGIO, JULIE MAI (OD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MAI
Last Name:DEMAGGIO
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 1:1603 HACKNEY DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4262
Mailing Address - Country:US
Mailing Address - Phone:214-728-9895
Mailing Address - Fax:
Practice Address - Street 1:5325 MCPHERSON BLVD STE 125
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-6028
Practice Address - Country:US
Practice Address - Phone:817-935-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8477T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist