Provider Demographics
NPI:1316027311
Name:TRIPPUTI, MIGUEL ARIEL (OD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ARIEL
Last Name:TRIPPUTI
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 1:5223 BELLAIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3901
Mailing Address - Country:US
Mailing Address - Phone:713-666-8636
Mailing Address - Fax:713-666-2343
Practice Address - Street 1:5223 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3901
Practice Address - Country:US
Practice Address - Phone:713-666-8636
Practice Address - Fax:713-666-2343
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E06VMedicare ID - Type UnspecifiedOPTOMETRIST