Provider Demographics
NPI:1003000472
Name:FUENTES, EDGAR
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:
Last Name:FUENTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 BELLAIRE BLVD
Mailing Address - Street 2:STE 112
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5537
Mailing Address - Country:US
Mailing Address - Phone:713-771-7867
Mailing Address - Fax:713-771-7869
Practice Address - Street 1:5800 BELLAIRE BLVD
Practice Address - Street 2:STE 112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5537
Practice Address - Country:US
Practice Address - Phone:713-771-7867
Practice Address - Fax:713-771-7869
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician