Provider Demographics
NPI:1851749667
Name:PRIETO-AYALA, CLARISSA (OD)
Entity Type:Individual
Prefix:MS
First Name:CLARISSA
Middle Name:
Last Name:PRIETO-AYALA
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 1:11670 PINEMONT RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77328-7237
Mailing Address - Country:US
Mailing Address - Phone:713-505-0158
Mailing Address - Fax:
Practice Address - Street 1:11670 PINEMONT RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77328-7237
Practice Address - Country:US
Practice Address - Phone:713-505-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9004T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist