MEDICARE: MR. ENRIQUE ATUESTA OPTICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	DR0773	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699936286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ENRIQUE ATUESTA OPTICIAN

Provider Business Mailing Address
First Line	:	5739 BELLAIRE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-5505
Country	:	US
Telephone Number	:	713-668-1307
Fax Number	:	713-668-0110

Provider Business Practice Location Address
First Line	:	5739 BELLAIRE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-5505
Country	:	US
Telephone Number	:	713-668-1307
Fax Number	:	713-668-0110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

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