Provider Demographics
NPI:1740628171
Name:DR DEBORAH E FONTENETTE
Entity type:Organization
Organization Name:DR DEBORAH E FONTENETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PETRICT
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-222-1889
Mailing Address - Street 1:5164 ALDINE MAIL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039-3802
Mailing Address - Country:US
Mailing Address - Phone:281-449-7400
Mailing Address - Fax:713-674-9314
Practice Address - Street 1:5164 ALDINE MAIL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-3802
Practice Address - Country:US
Practice Address - Phone:281-449-7400
Practice Address - Fax:713-674-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0430680001Medicare NSC