Provider Demographics
NPI:1356910913
Name:MARQUART, LIZABETH
Entity type:Individual
Prefix:
First Name:LIZABETH
Middle Name:
Last Name:MARQUART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZABETH
Other - Middle Name:MARQUART
Other - Last Name:FENSTERMAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 207158
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7158
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:54 THE LEGENDS PKWY STE 151
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3803
Practice Address - Country:US
Practice Address - Phone:636-938-7010
Practice Address - Fax:636-938-7141
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021022457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist