Provider Demographics
NPI:1104057363
Name:KESSNER, MARC DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:DAVID
Last Name:KESSNER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1441 CONTOUR DR APT 831
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1267
Mailing Address - Country:US
Mailing Address - Phone:210-826-1720
Mailing Address - Fax:210-826-1792
Practice Address - Street 1:4331 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2101
Practice Address - Country:US
Practice Address - Phone:210-826-1720
Practice Address - Fax:210-826-1792
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7818-T152W00000X
VA0618001882152W00000X
TX7818TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA021656M39Medicare PIN