Provider Demographics
NPI:1639363997
Name:CRISTINA DE LA PENA, O.D., P.A.
Entity Type:Organization
Organization Name:CRISTINA DE LA PENA, O.D., P.A.
Other - Org Name:PREMIER VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:DE LA PENA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-370-3030
Mailing Address - Street 1:10850 LOUETTA ROAD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3538
Mailing Address - Country:US
Mailing Address - Phone:281-370-3030
Mailing Address - Fax:
Practice Address - Street 1:10850 LOUETTA ROAD
Practice Address - Street 2:SUITE 1000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3538
Practice Address - Country:US
Practice Address - Phone:281-370-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6209TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613215Medicare PIN
TX6164850001Medicare NSC