Provider Demographics
NPI:1063728277
Name:FERMIL, MARIE LULETTE PINTO (OD)
Entity type:Individual
Prefix:DR
First Name:MARIE LULETTE
Middle Name:PINTO
Last Name:FERMIL
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 1:7364 BRAYS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3101
Mailing Address - Country:US
Mailing Address - Phone:925-978-3248
Mailing Address - Fax:
Practice Address - Street 1:1325 GEORGE DIETER DR STE I2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7484
Practice Address - Country:US
Practice Address - Phone:915-591-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X, 390200000X
VA0618002793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program