Provider Demographics
NPI:1922004415
Name:BUETTNER, GARY LEWIS (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEWIS
Last Name:BUETTNER
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 1:902 FROSTWOOD DR
Mailing Address - Street 2:STE 256
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2418
Mailing Address - Country:US
Mailing Address - Phone:713-935-9485
Mailing Address - Fax:713-935-0326
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:STE 256
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2418
Practice Address - Country:US
Practice Address - Phone:713-935-9485
Practice Address - Fax:713-935-0326
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1984TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80835QOtherBCBS
TX124530005Medicaid
918844OtherEYEMED
5462141OtherAETNA
8112452OtherBLUE LINK
P00041583Medicare PIN
5462141OtherAETNA
TX124530005Medicaid