Provider Demographics
NPI:1841630936
Name:CASIS, AMIDEMEBIE DECHAVEZ (BS, OD)
Entity type:Individual
Prefix:MISS
First Name:AMIDEMEBIE
Middle Name:DECHAVEZ
Last Name:CASIS
Suffix:
Gender:F
Credentials:BS, OD
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:
Other - Last Name:CASIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4139S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8720
Mailing Address - Country:US
Mailing Address - Phone:903-534-8349
Mailing Address - Fax:903-581-8203
Practice Address - Street 1:3915 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2169
Practice Address - Country:US
Practice Address - Phone:936-560-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8158T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist