Provider Demographics
NPI:1154974509
Name:WESTBROOK, MARCELINE GREY (OD)
Entity type:Individual
Prefix:
First Name:MARCELINE
Middle Name:GREY
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 RUNYAN CT
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7210
Mailing Address - Country:US
Mailing Address - Phone:936-635-5593
Mailing Address - Fax:
Practice Address - Street 1:NORTHWEST VILLAGE 1715
Practice Address - Street 2:WEST LOOP 281
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2858
Practice Address - Country:US
Practice Address - Phone:903-475-1021
Practice Address - Fax:903-759-2833
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9710T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist