MEDICARE: DR. DEBORAH ELLEN FONTENETTE O.D.

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	152W00000X	Optometrist	02604	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	:	1508977372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH ELLEN FONTENETTE O.D.

Provider Business Mailing Address
First Line	:	906 WAYSIDE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011
Country	:	US
Telephone Number	:	713-921-6262
Fax Number	:	713-674-9314

Provider Business Practice Location Address
First Line	:	906 WAYSIDE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011-2518
Country	:	US
Telephone Number	:	713-678-8288
Fax Number	:	713-678-4013

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/24/2018

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