Provider Demographics
NPI:1235222720
Name:BELLO, M (OD PC)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:
Last Name:BELLO
Suffix:
Gender:F
Credentials:OD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N LUTTERLOH AVE
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1421
Mailing Address - Country:US
Mailing Address - Phone:254-865-7979
Mailing Address - Fax:
Practice Address - Street 1:113 N LUTTERLOH AVE
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-1421
Practice Address - Country:US
Practice Address - Phone:254-865-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4428T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20463OtherSCOTT & WHITE HEALTH PLAN
TXP00109892OtherRAILROAD MEDICARE
TX108385100OtherFIRST CARE
TXP00109892OtherRAILROAD MEDICARE
TX20463OtherSCOTT & WHITE HEALTH PLAN
TXTXB125531Medicare PIN