Provider Demographics
NPI:1073595849
Name:QUINTERO, MICHELE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ANN
Last Name:QUINTERO
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 1:9344 JONES RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5361
Mailing Address - Country:US
Mailing Address - Phone:281-897-0005
Mailing Address - Fax:281-897-0008
Practice Address - Street 1:9344 JONES RD
Practice Address - Street 2:SUITE H
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5361
Practice Address - Country:US
Practice Address - Phone:281-897-0005
Practice Address - Fax:281-897-0008
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6615TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1763393-01Medicaid
TX81432QOtherBLUE CROSS & BLUE SHEILD NUMBER
TX06615TGOtherOPTOMETRY LICENSE
TX8F3207Medicare PIN
TXV02296Medicare UPIN
TX81432QOtherBLUE CROSS & BLUE SHEILD NUMBER