Provider Demographics
NPI:1508977372
Name:FONTENETTE, DEBORAH ELLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ELLEN
Last Name:FONTENETTE
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 1:906 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011
Mailing Address - Country:US
Mailing Address - Phone:713-921-6262
Mailing Address - Fax:713-674-9314
Practice Address - Street 1:906 WAYSIDE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-2518
Practice Address - Country:US
Practice Address - Phone:713-678-8288
Practice Address - Fax:713-678-4013
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112306061Medicaid
TXT13299Medicare UPIN
TXE35E4Medicare ID - Type Unspecified