Provider Demographics
NPI:1043326622
Name:PENA-GARCIA, DEANNA I (OD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:I
Last Name:PENA-GARCIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 OLD KATY RD
Mailing Address - Street 2:SUITE N100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2134
Mailing Address - Country:US
Mailing Address - Phone:713-668-6828
Mailing Address - Fax:832-280-3636
Practice Address - Street 1:2855 GRAMERCY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1756
Practice Address - Country:US
Practice Address - Phone:713-668-1828
Practice Address - Fax:713-395-1666
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05485TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5520Medicare PIN
TXTXB103325Medicare PIN