Provider Demographics
NPI:1982237517
Name:TUNPRASERT, ANESSA (OD)
Entity Type:Individual
Prefix:
First Name:ANESSA
Middle Name:
Last Name:TUNPRASERT
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 1:5560 MURTON PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-3762
Mailing Address - Country:US
Mailing Address - Phone:682-227-1307
Mailing Address - Fax:
Practice Address - Street 1:732 W PIPELINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4928
Practice Address - Country:US
Practice Address - Phone:817-799-4016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9915T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist