Provider Demographics
NPI:1043764780
Name:BUENTELLO, JOSEPH CHRISTOPHER (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CHRISTOPHER
Last Name:BUENTELLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S US HIGHWAY 281
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3712
Mailing Address - Country:US
Mailing Address - Phone:956-383-5581
Mailing Address - Fax:
Practice Address - Street 1:2301 S US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3712
Practice Address - Country:US
Practice Address - Phone:956-383-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9092T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist