Healthcare Provider Details

I. General information

NPI: 1952597270
Provider Name (Legal Business Name): LESTAVIA DUPLANTIER, OD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 06/21/2018
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 Number06307T
License Number StateTX

VIII. Authorized Official

Name: LESTAVIA P. DUPLANTIER
Title or Position: O.D.
Credential: O.D.
Phone: 281-459-3700