Provider Demographics
NPI:1073185278
Name:ABEBE, FORTUNA T (OD)
Entity Type:Individual
Prefix:DR
First Name:FORTUNA
Middle Name:T
Last Name:ABEBE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-5736
Mailing Address - Country:US
Mailing Address - Phone:832-359-3326
Mailing Address - Fax:
Practice Address - Street 1:3100 WESLAYAN ST STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5752
Practice Address - Country:US
Practice Address - Phone:713-526-1600
Practice Address - Fax:713-526-0679
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10323T152W00000X
GAOPT003339.152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist