Provider Demographics
NPI:1780789321
Name:MARQUEZ, EDWARD ANTHONY (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 PABLO KISEL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4280
Mailing Address - Country:US
Mailing Address - Phone:956-621-3311
Mailing Address - Fax:956-621-3324
Practice Address - Street 1:3001 PABLO KISEL BLVD STE E
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4280
Practice Address - Country:US
Practice Address - Phone:956-621-3311
Practice Address - Fax:956-621-3324
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6901T152W00000X
TX06901TG152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6901TOtherSTATE BOARD LICENSE