Provider Demographics
NPI:1932738481
Name:METTA FALLENA, ENRIQUE (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:METTA FALLENA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 PALOMAR ST STE A17
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2663
Mailing Address - Country:US
Mailing Address - Phone:619-992-4291
Mailing Address - Fax:619-422-2385
Practice Address - Street 1:651 PALOMAR ST STE A17
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2663
Practice Address - Country:US
Practice Address - Phone:619-992-4291
Practice Address - Fax:619-422-2385
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40581156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician