Provider Demographics
NPI:1689830598
Name:BELAUSTEGUI, AMBER LOUISE (OD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LOUISE
Last Name:BELAUSTEGUI
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 1:3620 MAYBERRY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-2131
Mailing Address - Country:US
Mailing Address - Phone:775-525-3377
Mailing Address - Fax:775-549-6095
Practice Address - Street 1:3620 MAYBERRY DR STE 103
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-2131
Practice Address - Country:US
Practice Address - Phone:775-525-3377
Practice Address - Fax:775-549-6095
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1689830598Medicaid