Healthcare Provider Details

I. General information

NPI: 1316074545
Provider Name (Legal Business Name): LESTAVIA DUPLANTIER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 E SAM HOUSTON PKWY N STE A
HOUSTON TX
77049-2524
US

IV. Provider business mailing address

5815 E SAM HOUSTON PKWY N STE A
HOUSTON TX
77049-2524
US

V. Phone/Fax

Practice location:
  • Phone: 281-459-3700
  • Fax: 281-459-9700
Mailing address:
  • Phone: 281-459-3700
  • Fax: 281-459-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6307T
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number6307T
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number6307T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: